Zhang Rui, Feng Wenjin, Feng Kai, Sun Fengkai, Ren Xueyun, Wang Huabin, Yang Ru
Department of Pediatrics, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, China.
Shandong Provincial Key Medical and Health Discipline of Pediatric Internal Medicine, Affiliated Hospital of Jining Medical University, Jining, China.
PLoS One. 2025 Aug 1;20(8):e0329453. doi: 10.1371/journal.pone.0329453. eCollection 2025.
Acute kidney injury (AKI) is a prevalent and critical complication in pediatric patients, severely influencing both survival outcomes and quality of life. This research seeks to evaluate the prognostic value of the lactate/albumin ratio (LAR) in predicting short-term outcomes for children diagnosed with AKI. A retrospective analysis was conducted using data from the Pediatric Intensive Care database, covering the period from 2010 to 2018. The relationship between the LAR and in-hospital mortality was explored using smoothing curve fitting, multivariate logistic regression, and Kaplan-Meier survival analysis. Receiver operating characteristic (ROC) analysis was performed to evaluate the predictive capability of LAR for in-hospital mortality. A total of 631 pediatric patients with AKI were included in this study. Smoothing curve fitting revealed a nearly linear positive association between the LAR and in-hospital mortality. Multivariate logistic regression analysis identified LAR as an independent predictor of in-hospital mortality (OR 2.58, 95% CI 1.85-3.59). Kaplan-Meier survival analysis showed that patients with a higher LAR had a significantly greater 30-day mortality rate compared to those with lower LAR values. ROC curve analysis demonstrated an area under the curve of 0.85 (95% CI 0.80-0.90). At the optimal cutoff value of 0.80, the sensitivity was 80.42%, specificity was 77.97%, and accuracy was 80.19%. These results suggest that LAR is a promising prognostic indicator of mortality in pediatric patients with AKI, and could serve as an early indicator of risk stratification.
急性肾损伤（AKI）是儿科患者中常见且严重的并发症，严重影响生存结局和生活质量。本研究旨在评估乳酸/白蛋白比值（LAR）对诊断为AKI的儿童短期预后的预测价值。使用儿科重症监护数据库2010年至2018年的数据进行回顾性分析。采用平滑曲线拟合、多因素逻辑回归和Kaplan-Meier生存分析探讨LAR与住院死亡率之间的关系。进行受试者工作特征（ROC）分析以评估LAR对住院死亡率的预测能力。本研究共纳入631例AKI儿科患者。平滑曲线拟合显示LAR与住院死亡率之间存在近乎线性的正相关。多因素逻辑回归分析确定LAR是住院死亡率的独立预测因素（OR 2.58，95%CI 1.85-3.59）。Kaplan-Meier生存分析表明，与LAR值较低的患者相比，LAR较高的患者30天死亡率显著更高。ROC曲线分析显示曲线下面积为0.85（95%CI 0.80-0.90）。在最佳截断值为0.80时，灵敏度为80.42%，特异度为77.97%，准确度为80.19%。这些结果表明，LAR是AKI儿科患者死亡率的一个有前景的预后指标，可作为风险分层的早期指标。
