In pediatric patients with traumatic brain injury, admission lactate-to-albumin ratio values were associated with mortality and demonstrated an area under the curve of 0.854, compared with 0.881 for the pediatric Glasgow Coma Scale and 0.861 for the Pediatric Risk of Mortality III score. In the study of 98 pediatric patients, the overall mortality rate was 9%.
In a retrospective cross-sectional study, researchers evaluated pediatric patients with traumatic brain injury admitted to a pediatric intensive care unit between January 2020 and June 2024, comparing clinical and laboratory findings between survivors and non-survivors.
Non-survivors had statistically significantly higher Pediatric Risk of Mortality III (PRISM III) scores and lower pediatric Glasgow Coma Scale (pGCS) and Pediatric Trauma Score values. Median PRISM III scores were 30 vs 3, and median pGCS scores were 3 vs 14 in non-survivors vs survivors.
Non-survivors also had higher lactate levels (9.2 vs 2.5 mmol/L), lower albumin levels (2.6 vs 4.0 g/dL), and higher lactate-to-albumin ratio (LAR) values (4.09 vs 0.65).
Receiver operating characteristic analysis showed that the pediatric Glasgow Coma Scale had the highest discriminatory ability for mortality (area under the curve [AUC], 0.881), followed by the PRISM III score (AUC, 0.861). Among inflammatory indices, LAR had an AUC of 0.854, with a cutoff greater than 0.68 corresponding to 89% sensitivity and 78% specificity.
Other inflammatory indices—including the systemic inflammation response index, neutrophil-to-lymphocyte ratio, pan-immune-inflammation value, and systemic immune-inflammation index—were statistically significantly higher in non-survivors, with AUC values ranging from 0.707 to 0.777. Platelet-to-lymphocyte ratio did not differ statistically significantly between groups.
Non-survivors more frequently had hypotension and subarachnoid hemorrhage and required more intensive interventions, including mechanical ventilation, renal replacement therapy, and therapeutic plasma exchange.
“LAR at admission, along with the pGCS score, is a valuable predictor of mortality in pediatric patients with TBI,” wrote lead researcher Özlem Bostan Gayret, MD, of the Department of Pediatrics, University of Health Sciences, Bağcılar Training and Research Hospital in Turkey, and Istanbul University Institute of Health Sciences, Child Health Institute, Social Pediatrics PhD Program in Turkey, and colleagues. The researchers noted this is the first study to evaluate LAR as a prognostic marker in pediatric traumatic brain injury.
Limitations included the single-center, retrospective design and the small number of non-survivors, which may affect generalizability. The researchers also noted variability in the time between injury and blood sampling, and that the PRISM III score was calculated within 24 hours of pediatric intensive care unit admission.
The researchers reported no conflicts of interest.
Source: Medicine