{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T17:16:01Z","timestamp":1787591761041,"version":"build-2736575974"},"reference-count":52,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,4,19]],"date-time":"2025-04-19T00:00:00Z","timestamp":1745020800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background and Objectives: Sepsis is a critical condition with high mortality rates worldwide. The early identification of patients at an elevated risk of mortality remains a significant clinical challenge. The lactate\/albumin (L\/A) ratio has emerged as a potential prognostic biomarker in critically ill patients. This exploratory study aimed to evaluate the L\/A ratio as a predictor of mortality in patients with sepsis or septic shock and to describe the demographic and clinical characteristics of affected patients in a tertiary referral hospital in Western Mexico. Materials and Methods: A retrospective cross-sectional study was conducted including patients diagnosed with sepsis or septic shock between January 2022 and June 2023. Clinical and biochemical data, including serum lactate and albumin levels, were collected from medical records to calculate the L\/A ratio. The primary outcome was in-hospital mortality. The statistical analysis included receiver operating characteristic (ROC) curves to evaluate the L\/A ratio\u2019s discriminative capacity, a bivariate analysis, and a multivariate logistic regression to identify independent risk factors for mortality. Results: A total of 141 patients were included in the study, and the median L\/A ratio was significantly higher in non-survivors compared to survivors (0.95 vs. 0.60, p = 0.003). The ROC analysis showed an area under the curve (AUC) of 0.651, with a sensitivity of 36.5% and specificity of 82% at a cutoff value of 1.12. The multivariate analysis identified serum albumin levels and vasopressor use as independent predictors of mortality. Conclusions: The L\/A ratio demonstrates potential as a simple and accessible prognostic biomarker for mortality in sepsis, though its utility requires further validation in larger prospective studies.<\/jats:p>","DOI":"10.3390\/jcm14082825","type":"journal-article","created":{"date-parts":[[2025,4,20]],"date-time":"2025-04-20T20:24:16Z","timestamp":1745180656000},"page":"2825","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Prognostic Value of the Lactate\/Albumin Ratio in Sepsis-Related Mortality: An Exploratory Study in a Tertiary Care Center with Limited Resources in Western Mexico"],"prefix":"10.3390","volume":"14","author":[{"given":"Octavio","family":"Ponce-Orozco","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berenice","family":"Vicente-Hernandez","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sol","family":"Ramirez-Ochoa","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1177-1815","authenticated-orcid":false,"given":"Luis Asdr\u00faval","family":"Zepeda-Guti\u00e9rrez","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0798-7384","authenticated-orcid":false,"given":"Mauricio Alfredo","family":"Ambriz-Alarc\u00f3n","sequence":"additional","affiliation":[{"name":"Subdirecci\u00f3n M\u00e9dica, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara 44280, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6249-4737","authenticated-orcid":false,"given":"Gabino","family":"Cervantes-Guevara","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara 44280, Mexico"},{"name":"Department of Welfare and Sustainable Development, Centro Universitario del Norte, Universidad de Guadalajara, Colotlan 46200, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2935-8703","authenticated-orcid":false,"given":"Alejandro","family":"Gonzalez-Ojeda","sequence":"additional","affiliation":[{"name":"Biomedical Research Unit 02, Hospital de Especialidades, Centro M\u00e9dico Nacional de Occidente, Guadalajara 44350, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6230-8359","authenticated-orcid":false,"given":"Clotilde","family":"Fuentes-Orozco","sequence":"additional","affiliation":[{"name":"Biomedical Research Unit 02, Hospital de Especialidades, Centro M\u00e9dico Nacional de Occidente, Guadalajara 44350, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco Javier","family":"Hernandez-Mora","sequence":"additional","affiliation":[{"name":"Department of Human Reproduction, Growth and Child Development, Health Sciences University Center, Universidad de Guadalajara, Guadalajara 44280, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillermo A.","family":"Cervantes-Cardona","sequence":"additional","affiliation":[{"name":"Department of Philosophical, Methodological and Instrumental Disciplines, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, 44340, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6686-0183","authenticated-orcid":false,"given":"Janet Cristina","family":"Vazquez-Beltran","sequence":"additional","affiliation":[{"name":"School of Medicine, Instituto Politecnico Nacional, Mexico City 11340, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6333-9082","authenticated-orcid":false,"given":"Enrique","family":"Cervantes-P\u00e9rez","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Mexico"},{"name":"Department of Philosophical, Methodological and Instrumental Disciplines, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, 44340, Mexico"},{"name":"Departamento de Cl\u00ednicas, Centro Universitario de Tlajomulco, Universidad de Guadalajara, Tlajomulco de Zuniga 45641, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1001\/jama.2016.0289","article-title":"Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"Phillips","year":"2016","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/S0140-6736(19)32989-7","article-title":"Global, regional, and national sepsis incidence and mortality, 1990\u20132017: Analysis for the Global Burden of Disease Study","volume":"395","author":"Rudd","year":"2020","journal-title":"Lancet"},{"key":"ref_3","first-page":"486","article-title":"Sepsis and septic shock in emergency departments of Mexico: A multicenter point prevalence study","volume":"156","year":"2020","journal-title":"Gac. Med. Mex."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1016\/j.mpaic.2021.10.001","article-title":"Sepsis 2021: A review","volume":"22","author":"Wentowski","year":"2021","journal-title":"Anaesth. Intensive Care Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"119891","DOI":"10.1016\/j.cca.2024.119891","article-title":"Biomarkers in sepsis","volume":"562","author":"Saxena","year":"2024","journal-title":"Clin. Chim. Acta"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1007\/s00134-021-06506-y","article-title":"Surviving sepsis campaign: International guidelines for management of sepsis and septic shock 2021","volume":"47","author":"Evans","year":"2021","journal-title":"Intensive Care Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"109876","DOI":"10.1016\/j.resuscitation.2023.109876","article-title":"Predicting ICU admission and death in the Emergency Department: A comparison of six early warning scores","volume":"190","author":"Covino","year":"2023","journal-title":"Resuscitation"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Mart\u00edn-Rodr\u00edguez, F., and Mart\u00edn-Conty, J.L. (2021). Early warning scores in patients with suspected COVID-19 infection in emergency Departments. J. Personal. Med., 11.","DOI":"10.3390\/jpm11030170"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"260","DOI":"10.7861\/clinmedicine.19-3-260","article-title":"The National Early Warning Score 2 (NEWS2)","volume":"19","author":"Smith","year":"2019","journal-title":"Clin. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1136\/emj.2007.057661","article-title":"Modified early warning score predicts the need for hospital admission and inhospital mortality","volume":"25","author":"Burch","year":"2008","journal-title":"Emerg. Med. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1016\/0735-6757(87)90350-0","article-title":"The Rapid Acute Physiology Score","volume":"5","author":"Rhee","year":"1987","journal-title":"Am. J. Emerg. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1111\/j.1365-2796.2004.01321.x","article-title":"Rapid Emergency Medicine score: A new prognostic tool for in-hospital mortality in nonsurgical emergency department patients","volume":"255","author":"Olsson","year":"2004","journal-title":"J. Intern. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"281","DOI":"10.7861\/clinmedicine.6-3-281","article-title":"Prediction of in-hospital mortality and length of stay using an early warning scoring system: Clinical audit","volume":"6","author":"Paterson","year":"2006","journal-title":"Clin. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1754","DOI":"10.1001\/jama.286.14.1754","article-title":"Serial evaluation of the SOFA score to predict outcome in critically ill patients","volume":"286","author":"Ferreira","year":"2001","journal-title":"JAMA"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1097\/00003246-198510000-00009","article-title":"APACHE II: A severity of disease classification system","volume":"13","author":"Knaus","year":"1985","journal-title":"Crit. Care Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1007\/s00134-005-2763-5","article-title":"SAPS 3 Investigators. SAPS 3--From evaluation of the patient to evaluation of the intensive care unit. Part 2: Development of a prognostic model for hospital mortality at ICU admission","volume":"31","author":"Moreno","year":"2005","journal-title":"Intensive Care Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1001\/jama.2016.0288","article-title":"Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"Seymour","year":"2016","journal-title":"JAMA"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1001\/jama.2016.20329","article-title":"Prognostic Accuracy of Sepsis-3 Criteria for In-Hospital Mortality Among Patients With Suspected Infection Presenting to the Emergency Department","volume":"317","author":"Freund","year":"2017","journal-title":"JAMA"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1001\/jama.2016.20328","article-title":"Prognostic Accuracy of the SOFA Score, SIRS Criteria, and qSOFA Score for In-Hospital Mortality Among Adults With Suspected Infection Admitted to the Intensive Care Unit","volume":"317","author":"Raith","year":"2017","journal-title":"JAMA"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Spoto, S., Basili, S., Cangemi, R., D\u2019avanzo, G., Lupoi, D.M., Romiti, G.F., Argemi, J., Yuste, J.R., Lucena, F., and Locorriere, L. (2023). Mid-Regional Pro-Adrenomedullin Can Predict Organ Failure and Prognosis in Sepsis?. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms242417429"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e16204","DOI":"10.1097\/MD.0000000000016204","article-title":"The use of APACHE II, SOFA, SAPS 3, C-reactive protein\/albumin ratio, and lactate to predict mortality of surgical critically ill patients: A retrospective cohort study","volume":"98","author":"Lago","year":"2019","journal-title":"Medicine"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/2110-5820-3-12","article-title":"Clinical use of lactate monitoring in critically ill patients","volume":"3","author":"Bakker","year":"2013","journal-title":"Ann. Intensive Care"},{"key":"ref_23","first-page":"1","article-title":"Mexico: Health system review","volume":"22","author":"Block","year":"2020","journal-title":"Health Syst. Transit."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1097\/CCM.0000000000000742","article-title":"Lactate measurements in sepsis-induced tissue hypoperfusion: Results from the Surviving Sepsis Campaign database","volume":"43","author":"Casserly","year":"2015","journal-title":"Crit. Care Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1097\/MCC.0000000000000824","article-title":"Blood lactate levels in sepsis: In 8 questions","volume":"27","author":"Vincent","year":"2021","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1055\/s-0041-1733915","article-title":"What Is the Utility of Measuring Lactate Levels in Patients with Sepsis and Septic Shock?","volume":"42","author":"Weinberger","year":"2021","journal-title":"Semin. Respir. Crit. Care Med."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Lichtenauer, M., Wernly, B., Ohnewein, B., Franz, M., Kabisch, B., Muessig, J., Masyuk, M., Lauten, A., Schulze, P.C., and Hoppe, U.C. (2017). The Lactate\/Albumin Ratio: A Valuable Tool for Risk Stratification in Septic Patients Admitted to ICU. Int. J. Mol. Sci., 18.","DOI":"10.3390\/ijms18091893"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1097\/01.ccx.0000235208.77450.15","article-title":"Lactate and shock state: The metabolic view","volume":"12","author":"Levy","year":"2006","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Zhang, T., Chen, L., Kueth, G., Shao, E., Wang, X., Ha, T., Williams, D.L., Li, C., Fan, M., and Yang, K. (2024). Lactate\u2019s impact on immune cells in sepsis: Unraveling the complex interplay. Front. Immunol., 15.","DOI":"10.3389\/fimmu.2024.1483400"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1177\/0885066616685300","article-title":"Predictive Value of Serum Albumin Level for the Prognosis of Severe Sepsis Without Exogenous Human Albumin Administration: A Prospective Cohort Study","volume":"33","author":"Yin","year":"2018","journal-title":"J. Intensive Care Med."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Magnussen, B., Gradel, K.O., Jensen, T.G., Kolmos, H.J., Pedersen, C., Vinholt, P.J., and Lassen, A.T. (2016). Association between Hypoalbuminaemia and Mortality in Patients with Community-Acquired Bacteraemia Is Primarily Related to Acute Disorders. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0160466"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"263","DOI":"10.2147\/CLEP.S396247","article-title":"Albumin Level is Associated with Short-Term and Long-Term Outcomes in Sepsis Patients Admitted in the ICU: A Large Public Database Retrospective Research","volume":"15","author":"Cao","year":"2023","journal-title":"Clin. Epidemiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1177\/1099800419827600","article-title":"Serum Albumin Trend Is a Predictor of Mortality in ICU Patients With Sepsis","volume":"21","author":"Kendall","year":"2019","journal-title":"Biol. Res. Nurs."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1097\/SHK.0000000000001128","article-title":"Prognostic Value of The Lactate\/Albumin Ratio for Predicting 28-Day Mortality in Critically ILL Sepsis Patients","volume":"50","author":"Shin","year":"2018","journal-title":"Shock"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Chen, X., Zhou, X., Zhao, H., Wang, Y., Pan, H., Ma, K., and Xia, Z. (2021). Clinical Value of the Lactate\/Albumin Ratio and Lactate\/Albumin Ratio \u00d7 Age Score in the Assessment of Prognosis in Patients With Sepsis. Front. Med., 8.","DOI":"10.3389\/fmed.2021.732410"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.jcrc.2014.10.030","article-title":"Correlation of lactate\/albumin ratio level to organ failure and mortality in severe sepsis and septic shock","volume":"30","author":"Wang","year":"2015","journal-title":"J. Crit. Care"},{"key":"ref_37","first-page":"136","article-title":"\u00cdndice lactato\/alb\u00famina como predictor de mortalidad en sepsis y choque s\u00e9ptico","volume":"32","author":"Michel","year":"2018","journal-title":"Med. Cr\u00edt. Col. Mex. Med. Cr\u00edt."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2088","DOI":"10.1016\/j.ajem.2020.06.067","article-title":"Lactate\/albumin ratio: An early prognostic marker in critically ill patients","volume":"38","author":"Gharipour","year":"2020","journal-title":"Am. J. Emerg. Med."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Chebl, R.B., Jamali, S., Sabra, M., Safa, R., Berbari, I., Shami, A., Makki, M., Tamim, H., and Dagher, G.A. (2020). Lactate\/Albumin Ratio as a Predictor of In-Hospital Mortality in Septic Patients Presenting to the Emergency Department. Front. Med., 7.","DOI":"10.3389\/fmed.2020.517999"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2268","DOI":"10.1080\/07853890.2021.2009125","article-title":"The prognostic value of the lactate\/albumin ratio for predicting mortality in septic patients presenting to the emergency department: A prospective study","volume":"53","author":"Chebl","year":"2021","journal-title":"Ann. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1080\/00365513.2021.1901306","article-title":"Lactate\/albumin ratio is more effective than lactate or albumin alone in predicting clinical outcomes in intensive care patients with sepsis","volume":"81","author":"Cakir","year":"2021","journal-title":"Scand. J. Clin. Lab. Investig."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"939","DOI":"10.5455\/medscience.2021.06.204","article-title":"The effect of lactate\/albumin ratio on mortality in patients with sepsis","volume":"10","author":"Yucel","year":"2021","journal-title":"Med. Sci. Int. Med. J."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Shadvar, K., Nader-Djalal, N., Vahed, N., Sanaie, S., Iranpour, A., Mahmoodpoor, A., Vahedian-Azimi, A., Samim, A., and Rahimi-Bashar, F. (2022). Comparison of lactate\/albumin ratio to lactate and lactate clearance for predicting outcomes in patients with septic shock admitted to intensive care unit: An observational study. Sci. Rep., 12.","DOI":"10.1038\/s41598-022-14764-z"},{"key":"ref_44","first-page":"1743","article-title":"Using the lactate-to-albumin ratio to predict mortality in patients with sepsis or septic shock: A systematic review and meta-analysis","volume":"26","author":"Yoon","year":"2022","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e28748","DOI":"10.1097\/MD.0000000000028748","article-title":"Prognostic value of the lactate\/albumin ratio for predicting mortality in patients with pneumosepsis in intensive care units","volume":"101","author":"Findikli","year":"2022","journal-title":"Medicine"},{"key":"ref_46","first-page":"e36816","article-title":"Serum Lactate-Albumin Ratio: Soothsayer for Outcome in Sepsis","volume":"15","author":"Kabra","year":"2023","journal-title":"Cureus"},{"key":"ref_47","first-page":"136","article-title":"Lactate\/albumin index as a sepsis mortality predictor and septic shock","volume":"32","year":"2018","journal-title":"Med. Cr\u00edtica"},{"key":"ref_48","first-page":"662","article-title":"Asociaci\u00f3n del \u00edndice lactato\/alb\u00famina y la mortalidad en pacientes con choque s\u00e9ptico en la unidad de terapia intensiva","volume":"37","year":"2023","journal-title":"Med. Crit."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e28521","DOI":"10.1016\/j.heliyon.2024.e28521","article-title":"Biomarkers and sepsis severity as predictors of mechanical ventilation and mortality in COVID-19","volume":"10","year":"2024","journal-title":"Heliyon"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1016\/j.mayocp.2013.06.012","article-title":"Etiology and therapeutic approach to elevated lactate levels","volume":"88","author":"Andersen","year":"2013","journal-title":"Mayo Clin. Proc."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1097\/PCC.0000000000003317","article-title":"The Lactate-Albumin Ratio Predicts Multiple Organ Dysfunction Syndrome and Death, But Is It Ready to Use?","volume":"24","author":"Butt","year":"2023","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1192\/S1749367600003039","article-title":"Challenges of clinical trials in low- and middle-income countries","volume":"9","author":"Osei","year":"2012","journal-title":"Int. Psychiatry"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/8\/2825\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:17:54Z","timestamp":1760030274000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/8\/2825"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,19]]},"references-count":52,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["jcm14082825"],"URL":"https:\/\/doi.org\/10.3390\/jcm14082825","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,19]]}}}