Could lactate clearance be a marker of mortality in pediatric intensive care unit?

Abstract

Background/aim Hyperlactatemia is a common finding in critically ill patients and has significant prognostic implications. However, a single lactate measurement has not been correlated to mortality consistently. In this study, we aimed to correlate the clinical efficacy of lactate clearance for the prediction of mortality in pediatric intensive care unit patients. Materials and methods This retrospective observational study was performed in the pediatric intensive care unit in patients with lactate level >3 mmol/lt. Initial, 6 th h, and 24 th h lactate levels were recorded and lactate clearance was calculated using these values (lactate level at admission – level 6 h later × 100/lactate level at admission). Results A total of 172 patients were included in the study. Forty-four out of 172 patients died. Median (IQR) lactate (mmol/L) at admission was low in those who survived in comparison to nonsurvivors 4.4 (3.1) vs. 5.75 (7.7) (p = 0.002). Clearance at 6 th h was significantly lower in those who died (11.7%) than those who survived (36.7) (p = 0.001). 6 th h lactate clearance level <20.7% predicted mortality with a sensitivity of 63.6% and specificity of 69.5% along with a positive predictive value of 41.8 and a negative predictive value of 84.8 (p = 0.004). Both lactate levels and lactate clearance values were significantly predictive factors for mortality (p < 0.05). Only a positive moderate correlation was found between the percentage of PRISM-IV % and 6 th h lactate level. Conclusion The present study revealed that lactate clearance is a simple and rapid risk-stratification tool holding to be a potential biomarker of managing the treatment efficacy of children in the pediatric intensive care unit.

Procalcitonin and blood lactate level as predictive biomarkers in pediatric multiple trauma patients’ pediatric intensive care outcomes: A retrospective observational study

“…[25] In critically ill children, elevated lactate at hospital admission and lactate clearance are associated with mortality. [26,27] This study confirms this in a specific patient group admitted to the ICU post-multiple trauma. Our findings confirm that high lactate levels are associated with adverse clinical outcomes and extended ICU stays.…”