Analysis of serum lactate levels to predict in hospital mortality in critically ill children admitted to pediatric intensive care unit

Authors

  • Trilok Rao Srigiri Department of Paediatrics, Narayana medical College and hospital, Nellore , Andhra Pradesh, India
  • Partha Saradhi Manyam Department of Paediatrics, Narayana medical College and hospital, Nellore , Andhra Pradesh, India
  • Uma Mahesh Department of Paediatrics, Narayana medical College and hospital, Nellore , Andhra Pradesh, India
  • Gangadhar Belavadi Department of Paediatrics, Narayana medical College and hospital, Nellore , Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20194730

Abstract

Background: The predictive significance of lactate measurement at admission for mortality in critically ill children remains uncertain. Authors  objectives was to study evaluated the predictive value of blood lactate levels at admission and determined the cut-off values for predicting in-hospital mortality in the critically ill pediatric population.

Methods: A prospective observational study was done in 100 critically ill admissions to the pediatric intensive care unit (PICU), requiring hemodynamic/respiratory support.  The chi-square test for categorical variables performs the comparison.

Results:  Out of 100 patients, 22 (22%) expired. Mortality is highest in 10-16 age (7%). In the non-survivor group, the majority of patients were diagnosed as pneumonia (7.5%). Median lactate levels in non-survivors are 4.5 at admission when compared to 2.0 in survivors (p<0.001). The mortality rates left rate in the high lactate group (73%) is more when compared to intermediate (20%) and low-level groups (7%). Blood lactate was 75% sensitive and 90% specific at the optimal cut-off value of 33.7 mg/dl. The positive likelihood ratio of predicting death is more with a high lactate level (7.5) when compared to intermediate (0.8) and low levels (0.08). Sensitivity and Specificity with elevated lactate levels is the mortality 24 hrs (89%, 92%) than at admission (75%, 90%). The AUROC values with the admission lactate level are 0.86, and after 24 hrs are 0.95.

Conclusions: Blood lactate levels at admission predict mortality in critically ill children requiring hemodynamic/respiratory support.

References

Meregalli A, Oliveira RP, Friedman G. Occult hypoperfusion is associated with increased mortality in hemodynamically stable, high-risk, surgical patients. Crit care. 2004 Apr;8(2):R60-5.

Okorie ON, Dellinger P. Lactate: biomarker and potential therapeutic target. Crit Care Clini. 2011 Apr 1;27(2):299-326.

Bakker J, Coffernils M, Leon M, Gris P, Vincent JL. Blood lactate levels are superior to oxygen-derived variables in predicting outcome in human septic shock. Chest. 1991 Apr 1;99(4):956-62.

Hazebroek FW, Tibboel D, Mourik M, Bos AP, Molenaar JC. Withholding and withdrawal of life support from surgical neonates with life-threatening congenital anomalies. J Pediatr Surg. 1993 Sep 1;28(9):1093-7.

Gill MB. PICU Prometheus: ethical issues in the treatment of very sick children in paediatric intensive care. Mortality. 2005 Nov 1;10(4):262-75.

Hatherill M, McIntyre AG, Wattie M, Murdoch IA. Early hyperlactataemia in critically ill children. Intensive Care Med. 2000 Mar 1;26(3):314-8.

Morris KP, McShane P, Stickley J, Parslow RC. The relationship between blood lactate concentration, the Paediatric Index of Mortality 2 (PIM2) and mortality in paediatric intensive care. Intensive Care Med. 2012 Dec 1;38(12):2042-6.

Koliski A, Cat I, Giraldi DJ, Cat ML. Blood lactate concentration as prognostic marker in critically ill children. J Pediatr. 2005 Aug;81(4):287-92.

Mizock BA, Falk JL. Lactic acidosis in critical illness. Crit Care Med. 1992 Jan 1;20(1):80-93.

Munde A, Kumar N, Beri RS, Puliyel JM. Lactate Clearance as a Marker of Mortality in Pediatric Intensive Care Unit- -Research Brief. Indian Pediatr. July 15 2014;51.

Koliski A, Cat I, Giraldi DJ, Cat ML. Blood lactate concentrationas prognostic marker in critically ill children. J Pediatr. 2005;81:287-92.

Jat KR, Jhamb U, Gupta VK. Serum lactate levels as the predictor of outcome in pediatric septic shock. Indian J Crit Care Medicine: Peer-Reviewed, Official Publication Indian Society Crit Care Med. 2011 Apr;15(2):102-7.

Okorie ON, Dellinger P. Lactate: biomarker and potential therapeutic target. Crit Care Clini. 2011 Apr 1;27(2):299-326.

Garcia Sanz C, Ruperez Lucas M, Lopez-Herce Cid J. Prognostic value of the pediatric index of mortality (PIM) score and lactate values in critically-ill children. An Pediatr 2002;57:394-400.

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Published

2019-10-21

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Original Research Articles