Objectives: To study predictive value of C–Reactive protein (CRP) to albumin ratio and fluid overload for development of Multiple Organ Dysfunction Syndrome (MODS) and mortality in critically ill children and compare it with Pediatric Risk of Mortality (PRISM) III score .

Methods: This prospective cohort study was conducted in Pediatric Intensive care unit (PICU) of a tertiary care hospital of central India. PRISM-III scoring, CRP and albumin level were done within 24 hours of admission. Early and cumulative fluid overload were calculated. Sensitivity and specificity were calculated for CRP to albumin ratio and fluid overload for MODS and mortality and compared with PRISM III score.

Results: We enrolled 102 critically ill children. The median CRP/Albumin ratio was significantly higher in non-survivors than survivors (25.30 vs 3.37 respectively) (p-value <0.001). At cut-off value of 10.73, it has 72.6% sensitivity and 79.3% specificity. Patients with the ratio of 9.25 or higher was at a significant risk of developing MODS (p <0.0001). CRP/Albumin ratio also associated with increased risk for mechanical ventilation and inotrope use. Furthermore, we established Strong positive correlation (coefficient: 0.44; p<0.000) between CRP/Albumin ratio and PRISM III score. Though fluid balance was statistically insignificant for development of MODS and mortality but varied significantly between length of PICU stay (p = 0.007).

Conclusions: CRP to albumin ratio, an inexpensive statistically significant biomarker having comparable discriminatory power to that of PRISM III score for assessing critically ill children and fluid imbalance is a significant indicator of duration of PICU stay.

Ankita Mandal completed her Mbbs (Bachelor of Medicine and bachelor of Surgery) in the year 2018 from Calcutta National Medical College and Hospital, kolkata, West Bengal, India. Completed Master degree in Pediatric Medicine in 2023 from All India Institute of medical sciences, Bhopal, Madhya Pradesh, India. After that She worked as Senior Resident for 2 years in the department of Pediatrics at All India Institute of Medical sciences, Kalyani, West Bengal, India. Currently She is currently pursuing a fellowship course in Pediatric Critical Care at the Institute of Child Health, Kolkata.