Effectiveness of predicting in-hospital mortality in critically ill children by assessing blood lactate levels at admission

Abstract

BackgroundHyperlactatemia upon admission is a documented risk factor for mortality in critically ill adult patients. However, the predictive significance of a single lactate measurement at admission for mortality in the general population of critically ill children remains uncertain. This 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.MethodsWe enrolled 1109 critically ill children who were admitted to a pediatric intensive care unit between July 2008 and December 2010. Arterial blood samples were collected in the first 2 hours after admission, and the lactate levels were determined. The Pediatric Risk of Mortality III (PRISM III) scores were calculated during the first 24 hours after admission.ResultsOf the 1109 children admitted, 115 (10.4%) died in the hospital. The median (interquartile range) blood lactate level in critically ill children was 3.2 mmol/l (2.2-4.8). Among the children, 859 (77.5%) had a lactate concentration >2.0 mmol/l. The blood lactate level upon admission was significantly associated with mortality (odds ratio [OR] = 1.38; 95% confidence interval [CI], 1.30-1.46; p <0.001), even after adjustment for age, gender, and illness severity assessed by PRISM III (OR = 1.27; p <0.001). Multivariate regression analysis showed that a high blood lactate level (OR = 1.17; 95% CI, 1.07-1.29; p = 0.001), a high PRISM III score (OR = 1.15; 95% CI, 1.11-1.20; p <0.001), and a low serum albumin (OR =0.92; 95% CI, 0.88-0.96; p <0.001) were independent risk factors for mortality in critically ill children. Blood lactate achieved an area under-the-receiver-operating-characteristic curve (AUC) of 0.79 (p <0.001) for predicting mortality that was similar to that of PRISM III (AUC = 0.82; p <0.001). The p-value for a comparison of both AUCs was 0.318. Blood lactate displayed a sensitivity of 61% and a specificity of 86% in predicting mortality at the optimal cut-off value of 5.55 mmol/l, and the positive and negative likelihood ratios were 4.5 and 0.45, respectively.ConclusionsA high blood lactate level at admission is independently associated with and predictive of in-hospital mortality in the general population of critically ill children.

Evaluation of Hypoalbuminemia as a Predictor of Clinical Outcome in Critically Ill Children in Alexandria University Children's Hospital

“…Also in one large cohort study where serum albumin was one of the covariates in the regression analysis, hypoalbuminemia was a significant predictor of mortality in critically ill children. 18 The present study also showed that serum albumin level at admission was an important discriminator of mortality with an AUC of 0.694. In contrast; Durward et al 3 reported that the discriminatory ability of serum albumin level at admission was poor for detecting PICU mortality.…”

Core-Peripheral Temperature Gradient and Blood Lactate Level as Markers of Prognosis in Children With Dengue

“…Among undifferentiated children with SIRS, early hyperlactataemia is significantly associated with increased risk of organ dysfunction, resuscitative therapies and critical illness. [19] Upon multiple logistic regression analysis, lactate level (OR= 1.057) was found to be significantly associated with mortality (p= 0.019); however, the association of core to peripheral temperature gradient with mortality was not found to be significant (p= 0.476).…”

Blood lactate as a predictor of mortality in critically ill children

“…Past studies suggest that PRISM III can predict deaths and clinical outcomes in children [14][15][16] . The optimal cut-off level of lactate for predicting in-hospital mortality in critically ill children as per the study by Zhenjiang Bai et al was blood lactate level of 5.55 mmol/l (49.5 mg/dl), which had a sensitivity of 61% and a specificity of 86% 17 . This study also compared the prognostic performance of a lactate value at admission to PRISM III score and found that the prognostic accuracy of blood lactate for inhospital mortality was similar to that of the PRISM III score.…”