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