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Background <p>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.</p> Methods <p>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&#xa0;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.</p> Results <p>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; <i>P</i> = 0.031). Higher FAR tertiles correlated with decreased mortality risk (HR: 0.66, 95% CI: 0.44–1.00; <i>P</i> = 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, <i>P</i> &lt; 0.001) and 1.126 (95% CI: 0.669–1.895, <i>P</i> = 0.656), respectively. No significant interactions were observed between FAR and 28-day mortality, except in patients with malignant cancer (P for interaction &gt; 0.05). The results of the sensitivity analysis remained stable.</p> Conclusions <p>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.</p> Graphical Abstract <p></p>

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L-shaped association between fibrinogen to serum albumin ratio and all-cause mortality among critically ill children: a retrospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年8月23日

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  • Weichao He,
  • Jie Liu,
  • Rui Jiang,
  • Xinyu Yang,
  • Xujie Zhang,
  • Ruoyu Cao,
  • Weichao He

摘要

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Graphical Abstract