Abstract: Objective To investigate the relationship between neutrophil/albumin ratio (NAR) and the severity of sepsis in children with sepsis and to evaluate the use of NAR to predict death risk. Methods A total of 325 children with sepsis who were admitted to the Affiliated Hospital of Xuzhou Medical University from January 2017 to October 2019 were enrolled. According to their survival 28 days after the onset of sepsis, they were divided into two groups: a survival group (n=296) and a death group (n=29). According to their pediatric critical illness scores (PCIS), the survival group was divided into three groups: a critically severe group (n=36), a severe group (n=217) and a non-severe group (n=43). Their neutrophil count, white cell count, C reaction protein (CRP) and albumin levels and NAR were compared. The ROC curve was adopted to evaluate the predictive use of NAR on the risk of death in children with sepsis. Results Compared with the death group, remarkable decreases in NAR were found in the critically severe group, severe group and non-severe group (P<0.05). There were no statistical differences in white cell count, neutrophil count, CRP and albumin levels among the four groups (P>0.05). Compared with the death group, the survival group presented significantly decreased NAR (P<0.05). There were no statistical differences in neutrophil count and albumin level between the survival group and the death group (P>0.05). According to ROC curve, when NAR was 0.45, the AUC under ROC curve was 0.93, 95% CI (0.86-0.99), with a sensitivity of 90.91% and a specificity of 91.67%. Conclusions NAR can well reflect the severity of sepsis, and has a positive role in predicting the risk of death in children with sepsis.