Admission Lactate-to-Albumin Ratio as a Predictor of Severe Maternal Outcomes in Postpartum Haemorrhage
DOI:
https://doi.org/10.53350/pjmhs02026208.6Keywords:
Postpartum haemorrhage; lactate-to-albumin ratio; maternal outcomes; haemorrhagic shock; massive transfusion; risk predictionAbstract
Background: Postpartum haemorrhage is an obstetric emergency which may quickly escalate to shock, coagulopathy, organ failure and death. Conventional vital signs and haemoglobin may underestimate the severity of blood-loss early on, and the identification of women at risk is difficult.
Objectives: To assess the predictive value of admission lactate/albumin ratio (LAR) in women with postpartum haemorrhage (PPH) on severe maternal outcomes.
Methods: This prospective observational cohort study involved 70 women at Lady Willingdon Hospital, who had primary postpartum haemorrhage from April 2025 to January 2026. Venous lactate and serum albumin were obtained within 30 minutes of recognition of haemorrhage and lactate to albumin ratio (L:ALB) was calculated. Severe maternal outcome defined as either maternal death, peripartum hysterectomy, transfusion of ≥5 PRBC units, vasopressor support, disseminated intravascular coagulation, invasive mechanical ventilation, cardiac arrest or renal replacement therapy. ROC and logistic regression analyses were used.
Results: There were 18 women (25.7%) with severe maternal outcomes. The median lactate-to-albumin ratio was significantly higher in women with severe outcome than in women without severe outcome (1.72 versus 0.66; p<0.001). The ratio demonstrated good discriminatory ability with an area under the curve of 0.88. With a threshold value of 0.95, 83.3% sensitivity, 78.8% specificity, 57.7% PPV and 93.2% NPV were obtained. The ratio, after taking into account estimated blood loss, was independently associated with severe maternal outcomes at a ratio of 0.95 or less (adjusted odds ratio 6.74; 95% confidence interval 1.72 – 26.46, p=0.006).
Conclusions: Admission lactate/albumin ratio could be a tool to identify women at risk of complications after PPH.
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Copyright (c) 2026 Binyamin Butt, Iram Yousaf, Maliha Amjad, Faiza Iqbal, Rubab Akram, Tehreem Hayat
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