Association of lactate-albumin ratio with native liver survival in paediatric acute liver failure: a 10-year retrospective study

Background Paediatric acute liver failure (PALF) is a severe life-threatening condition with complex aetiologies and high mortality rates. Prognostic research, particularly in the Chinese paediatric population, is limited. The lactate-albumin ratio (LAR) is a potential prognostic indicator for adverse outcomes in critical illness, and its correlation with survival with the native liver (SNL) in PALF patients requires further study. LAR was calculated as follows: [lactate (mmol/L)/serum albumin (g/L)×100%]. This study utilized early LAR, defined as the initial measurement of lactate and albumin levels conducted within the first 24h following hospital admission, to investigate the correlation between LAR and SNL in PALF.Materials and Methods This retrospective cohort study included 77 patients with PALF. The data collected included demographic information, etiologies, complications, laboratory findings, and the Liver Injury Unit score. Logistic regression, smooth curve fitting, generalized additive models, and interaction effects analysis were used for statistical analysis.Results Among 77 patients, 46.8% (36 cases) had SNL, with 14.3% (11 cases) requiring transplantation. A significant decrease in SNL was associated with higher LAR (p = 0.005), with a 4% decline in SNL for each 1% increase in LAR. When the LAR≥ 10.5%, the odds ratios(ORs) for SNL in Models I, II, and III were 0.259 (95% confidence interval(CI) 0.101-0.668), 0.213 (95% CI 0.076-0.6), and 0.053 (95% CI 0.007-0.378), respectively. Smooth curve fitting confirmed a linear relationship (p for nonlinearity = 0.531). The subgroup analysis showed an association between LAR and SNL in non-shocked patients (OR 0.1121, 95% CI 0.0153-0.8206) and significant interactions in patients with higher-grade hepatic encephalopathy (p < 0.001). No significant differences in clinical outcomes were observed regardless of etiology.Conclusions Our findings suggest a significant correlation between LAR and SNL in patients with PALF from Northeast China. Elevated LAR is predictive of a reduced probability of surviving PALF without the need for liver transplantation, highlighting its potential as a prognostic marker in PALF.