Association Between the First-Hour Intravenous Fluid Volume and Mortality in Pediatric Septic Shock

Eisenberg, Matthew; Riggs, Ruth; Paul, Raina; Balamuth, Fran; Richardson, Troy; Souza, Heidi Gruhler De; Abbadesa, Mary Kate; DeMartini, Theodore K.M.; Frizzola, Meg; Lane, Roni D.; Lloyd, Julia; Melendez, Elliot; Patankar, Nikhil; Rutman, Lori; Sebring, Amanda; Timmons, Zebulon; Scott, Halden F.

doi:10.1016/j.annemergmed.2022.04.008

Cited by 4 publications

(1 citation statement)

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“…The use of lactate in monitoring hemodynamic resuscitation in general populations of children with septic shock is recommended in the evidence-based consensus guidelines of the Surviving Sepsis Campaign and is already common practice in many pediatric EDs in the care of sepsis ( 78 , 87 ). While this study cannot establish exactly which clinical actions should be taken based on a specific lactate level in a PHO patient, it gives support to this practice in PHO patients with suspected sepsis in the ED, in alignment with current standard of care for all children with sepsis.…”

Section: Discussionmentioning

confidence: 99%

Serum lactate is associated with increased illness severity in immunocompromised pediatric hematology oncology patients presenting to the emergency department with fever

et al. 2022

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IntroductionDetermining which febrile pediatric hematology/oncology (PHO) patients will decompensate from severe infection is a significant challenge. Serum lactate is a well-established marker of illness severity in general adult and pediatric populations, however its utility in PHO patients is unclear given that chemotherapy, organ dysfunction, and cancer itself can alter lactate metabolism. In this retrospective analysis, we studied the association of initial serum lactate in febrile immunosuppressed PHO patients with illness severity, defined by the incidence of clinical deterioration events (CDE) and invasive bacterial infection (IBI) within 48 hours.MethodsReceiver operating characteristic (ROC) curves were reported using initial lactate within two hours of arrival as the sole predictor for CDE and IBI within 48 hours. Using a generalized estimating equations (GEE) approach, the association of lactate with CDE and IBI within 48 hours was tested in univariate and multivariable analyses including covariates based on Quasi-likelihood under Independence Model Criterion (QIC). Additionally, the association of lactate with secondary outcomes (i.e., hospital length of stay (LOS), intensive care unit (PICU) admission, PICU LOS, non-invasive infection) was assessed.ResultsAmong 897 encounters, 48 encounters had ≥1 CDE (5%), and 96 had ≥1 IBI (11%) within 48 hours. Elevated lactate was associated with increased CDE in univariate (OR 1.77, 95%CI: 1.48-2.12, p<0.001) and multivariable (OR 1.82, 95%CI: 1.43-2.32, p<0.001) analyses, longer hospitalization (OR 1.15, 95%CI: 1.07-1.24, p<0.001), increased PICU admission (OR 1.68, 95%CI: 1.41-2.0, p<0.001), and longer PICU LOS (OR 1.21, 95%CI: 1.04-1.4, p=0.01). Elevated lactate was associated with increased IBI in univariate (OR 1.40, 95%CI: 1.16-1.69, p<0.001) and multivariable (OR 1.49, 95%CI: 1.23-1.79, p<0.001) analyses. Lactate level was not significantly associated with increased odds of non-invasive infection (p=0.09). The QIC of the model was superior with lactate included for both CDE (305 vs. 325) and IBI (563 vs. 579).ConclusionsThese data demonstrated an independent association of elevated initial lactate level and increased illness severity in febrile PHO patients, suggesting that serum lactate could be incorporated into future risk stratification strategies for this population.

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Section: Discussionmentioning

confidence: 99%