摘要Background Venoarterial extracorporeal membrane oxygenation induces an inflammatory response upon initiation.The neutrophil percentage-to-albumin ratio is a promising biomarker for predicting mortality in patients with systemic inflam-mation.This study aimed to investigate the association between neutrophil percentage-to-albumin ratio and in-hospital mortality in pediatric patients with acute fulminant myocarditis undergoing extracorporeal membrane oxygenation and to develop a PEACE model for predicting mortality in these patients.Methods This retrospective study included pediatric patients diagnosed with acute fulminant myocarditis who underwent venoarte-rial extracorporeal membrane oxygenation between July 2015 and August 2022.Multivariable logistic regression analysis was used to investigate the independent association between the neutrophil percentage-to-albumin ratio and the risk of in-hospital mortality.In addition,we utilized least absolute shrinkage and selection operator regression to select predictive factors,ultimately developing a nomogram to predict outcomes in pediatric patients receiving venoarterial extracorporeal membrane oxygenation.Results A total of 125 patients eligible for analysis were included in this study,with an in-hospital mortality rate of 28.8％.Multivariable logistic regression revealed that the neutrophil percentage-to-albumin ratio was an independent risk factor for in-hospital mortality in venoarterial extracorporeal membrane oxygenation patients.Restricted cubic splines revealed a posi-tive association between the two(Pnonlinearity=0.84).Least absolute shrinkage and selection operator regression and backward stepwise logistic regression identified age,cardiopulmonary resuscitation,lactate levels,and the neutrophil percentage-to-albumin ratio as key predictive factors.Using these factors,a nomogram(PEACE model)was developed to predict in-hospital mortality in venoarterial extracorporeal membrane oxygenation patients.The area under the receiver operating characteristic curve was 0.83[95％confidence interval(CI),0.74-0.92],with the inclusion of the neutrophil percentage-to-albumin ratio significantly enhancing the model's predictive accuracy.Conclusions The neutrophil percentage-to-albumin ratio may serve as a potential predictor for venoarterial extracorporeal membrane oxygenation in-hospital mortality in pediatric patients with acute fulminant myocarditis,suggesting that inflam-matory responses are associated with patient prognosis.The PEACE model is superior in predicting the prognosis of pediatric patients supported by venoarterial extracorporeal membrane oxygenation,and can help in clinical decision making.