A multicenter study in low‑ and middle‑income countries identified plasma lipopolysaccharide (LPS) concentration as a strong predictor of mortality in acutely ill children. Researchers measured circulating LPS on admission and found higher levels associated with increased risk of death, independent of standard clinical severity scores. The team argues LPS reflects translocation of gram-negative bacterial products and systemic endotoxemia, offering a mechanistic biomarker for risk stratification in pediatric critical care. The study calls for evaluation of bedside assays and consideration of LPS-guided interventions such as tailored antimicrobial strategies or adjunctive therapies. Before clinical adoption, prospective validation and investigation of interventional benefit from LPS-directed care pathways are required, alongside assessment of assay robustness in resource-limited settings.