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Objectives: Lactate/albumin (L/A) ratio is a biomarker in sepsis that has been shown to outperform lactate. This prospective study aims to validate the superior prognostic value of the L/A ratio to lactate in sepsis and septic shock. Methods: Prospective cohort conducted from September 2018 till February 2021 on adult patients presenting to the Emergency Department (ED) at a tertiary care centre with sepsis or septic shock. The primary outcome was the prognostic value of the L/A ratio compared to lactate with regards to mortality. Results: A total of 939 septic patients were included throughout the study period. A total of 236 patients developed septic shock. The AUC value of the L/A ratio in septic patients was 0.65 (95% CI 0.61-0.70) and was higher than that of lactate alone 0.60 (95% CI 0.55-0.64) with a p<.0001. The optimal L/A ratio cut-off threshold that separated survivors from non-survivors was found to be 0.115 for all septic patients. The AUC of the L/A ratio was significantly higher for patients with a lactate ≦2 mmol/L: 0.69 (95% CI 0.64-0.74) versus 0.60 (95% CI 0.54-0.66) with a p<.0001 as well as for patients with an albumin level less than 30 g/L (AUC = 0.69 95% CI= 0.62-0.75 vs AUC= 0.66 95% CI= 0.59-0.73, p<.04). Among septic shock patients there was no statically significant difference in the AUC value of the L/A ratio compared to lactate (0.53 95% CI 0.45-0.61 vs 0.50 95% CI 0.43-0.58 respectively with a p-value=.11). Conclusions: The L/A ratio is a better predictor of in-patient mortality than lactate in sepsis patients. This superiority was not found in the septic shock subgroup. Our results encourage the use of the ratio early in the ED as a superior prognostic tool in sepsis patients. [ABSTRACT FROM AUTHOR]