Introduction : The prognostic role of lactate to albumin (L/A) ratio has hardly been explored in severe sepsis patients.  This study examines the utility of L/A ratio as a clinical & prognostic marker in severe sepsis patients. Objectives : To investigate the potential utility of the lactate to albumin ratio as a prognostic marker for Multiple Organ Dysfunction Syndrome (MODS) and mortality in patients with severe sepsis and septic shock. Methodology: This prospective follow-up study was conducted with non-trauma adult (>18 years) ICU patients with severe sepsis for 4 months at R.L. Jalappa Hospital and Research Centre.  Clinical and laboratory data for day 1 (D1) and 2 (D2) were collected.  Results: We recruited 28 patients with a mean age 57.7 years (Standard deviation or SD 15.0 years), majority being female (n=17, 60.7%).  The median L/A was 1.96 (SD 0.54) and 1.74 (SD 0.51) on D1 & D2, respectively. The D1 L/A was positively correlated with  APACHE II score (Pearson’s correlation co-efficient or r=0.61, p<0.001) (figure 1), heart rate on D1 (r=0.52, p=0.004) and D2 (r=0.51, p=0.005), respiratory rate on D1 (r=0.77, p<0.001) and D2 (r=0.76, p<0.001), serum creatinine on D1 (r=0.8, p<0.001) and D2 (r=0.81, p<0.001); and negatively correlated with D1 mean arteriolar pressure (r=-0.43, p=0.02), platelets on D1 (r=-0.64, p<0.001) and D2 (r=-0.71, p<0.001). Three (10.7%) hospital deaths were reported and the median Lactate/albumin ratio for these patients (2.72, IQR 2.67 to 2.98) were high compared to those who survived (1.78, IQR 1.44 to 2.29) (p<0.05, Wilcoxon signed rank test).