He Weichao, Liu Jie, Jiang Rui, Yang Xinyu, Zhang Xujie, Cao Ruoyu, He Weichao
Department of Pediatrics, Cangzhou Central Hospital, No.16 Xinhua West street, Yunhe District, Cangzhou, 061000, China.
Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, 100853, Beijing, China.
BMC Pediatr. 2025 Aug 23;25(1):644. doi: 10.1186/s12887-025-06011-x.
While elevated fibrinogen-to-albumin ratio (FAR) correlates with all-cause mortality in adults, its prognostic value in pediatric intensive care units (PICUs) remains unclear. This study aimed to investigate the association between FAR and in-hospital all-cause mortality in critically ill pediatric patients.
We conducted a retrospective cohort study analyzing the PIC database from 2010 to 2018. Blood samples for fibrinogen and serum albumin were collected within 24 h of admission. The primary outcome was 28-day all-cause mortality. We utilized multivariable Cox proportional hazards regression, smooth curve fitting, and Kaplan-Meier survival curves, along with subgroup analyses and a two-piecewise linear regression model to assess associations.
A total of 5,087 patients (mean age 1.4 years; 44.7% female) were included. The 28-day mortality rate was 4.7% (240/5,087). FAR was independently associated with mortality risk (HR: 0.83, 95% CI: 0.70-0.98; P = 0.031). Higher FAR tertiles correlated with decreased mortality risk (HR: 0.66, 95% CI: 0.44-1.00; P = 0.005). The FAR-mortality relationship was L-shaped, with a threshold around 0.648. The effect sizes on the left and right sides of the inflection point were 0.076 (95% CI: 0.025-0.234, P < 0.001) and 1.126 (95% CI: 0.669-1.895, P = 0.656), respectively. No significant interactions were observed between FAR and 28-day mortality, except in patients with malignant cancer (P for interaction > 0.05). The results of the sensitivity analysis remained stable.
This study reveals an L-shaped relationship between FAR and 28-day in-hospital all-cause mortality in PICU patients, suggesting that FAR may serve as a prognostic marker for mortality in critically ill children.
虽然纤维蛋白原与白蛋白比值（FAR）升高与成年人的全因死亡率相关，但其在儿科重症监护病房（PICU）中的预后价值仍不明确。本研究旨在探讨FAR与危重症儿科患者院内全因死亡率之间的关联。
我们进行了一项回顾性队列研究，分析了2010年至2018年的PICU数据库。在入院后24小时内采集纤维蛋白原和血清白蛋白的血样。主要结局是28天全因死亡率。我们使用多变量Cox比例风险回归、平滑曲线拟合和Kaplan-Meier生存曲线，以及亚组分析和两段式线性回归模型来评估关联。
共纳入5087例患者（平均年龄1.4岁；44.7%为女性）。28天死亡率为4.7%（240/5087）。FAR与死亡风险独立相关（HR：0.83，95%CI：0.70-0.98；P = 0.031）。较高的FAR三分位数与降低的死亡风险相关（HR：0.66，95%CI：0.44-1.00；P = 0.005）。FAR与死亡率的关系呈L形，阈值约为0.648。拐点左侧和右侧的效应大小分别为0.076（95%CI：0.025-0.234，P < 0.001）和1.126（95%CI：0.669-1.895，P = 0.656）。除恶性肿瘤患者外，未观察到FAR与28天死亡率之间有显著交互作用（交互作用P > 0.05）。敏感性分析结果保持稳定。
本研究揭示了PICU患者中FAR与28天院内全因死亡率之间的L形关系，表明FAR可能作为危重症儿童死亡率的预后标志物。
