Blood lactate as a predictor of mortality in critically ill children

Abstract

Objective: To study blood lactate levels at admission in predicting mortality in critically ill children requiring haemodynamic / respiratory support.Method: A prospective observational study was done in 200 critically ill admissions to the paediatric intensive care unit (PICU), requiring haemodynamic / respiratory support. The demographic data, clinical status, organ involvement and therapeutic interventions were recorded in a predesigned proforma until hospital discharge or death. Lactate levels were estimated at admission and were correlated with the mortality and organ dysfunction Results:The geometric mean of lactate levels at admission in survivors and non survivors were 20.58 mg/dl and 50.48 mg/dl respectively. Blood lactate was 82.9% sensitive and 85.4% specific at the optimal cut-off value of 33.7 mg/dl. The positive likelihood ratio was 5.67 and the negative likelihood ratio 0.2. Conclusions:Blood lactate levels at admission predict mortality in critically ill children requiring haemodynamic/respiratory support.

Paediatric Risk of Mortality (PRISM) III Score and Serum Lactate Levels as Predictor of Outcome in Children Admitted to the Paediatric Intensive Care Unit

“…In a study by Bai Z et al (13), the median blood lactate level measured in critically ill patients was 3.2 mmol/L (2.2-4.8 mmol/L). Similarly, in a study by Chanderashekher et al (9), the mean lactate level among survivors was 2.28, and in a study by Gupta A et al (8), it was 2.77±1.77 mmol/L, which was comparable to the present study, where blood lactate was 2.95 mmol/L (1.83-4.48 mmol/L). In a retrospective cohort study by Morris KP et al (14), admission lactate in PICU non-survivors (6.6 mmol/L (SD=5.6)) was higher than in survivors (3.0 mmol/L (SD=2.5)), with a positive association with mortality.…”

“…The PRISM III score was significantly higher in patients who died (P=0.001), i.e., the PRISM III score was significantly associated with survival outcome in patients admitted to the PICU. The patient survival rate in the present study was 90.7%, but a few other studies showed the survival rate as 67% by Gupta A et al (8), 50% by Jat et al (12), and 24% by Chanderashekher et al (9). Therefore it is recommended that mortality risk is assessed using PRISM III at admission, as it is simple to use.…”

“…Lactate is a metabolite produced during anaerobic glycolysis (7,8). Lactate is an indicator of tissue hypoperfusion and cellular hypoxia, and elevated lactate levels in the blood are substantially associated with mortality (9). Due to its strong link to mortality, hyperlactatemia has been used as a measure of tissue hypoperfusion and cellular hypoxia.…”

“…In the past, studies have evaluated the predictive value of a single lactate measurement for mortality in adults (8). In the literature, lactate as a prognostic marker of mortality in pediatric populations is controversial (9,10).…”