Lactate as a predictor of mortality in Malawian children with WHO-defined pneumonia

Ramakrishna, Bharat; Graham, Stephen M.; Phiri, Ajib; Mankhambo, Limangeni; Duke, Trevor

doi:10.1136/archdischild-2011-300920

Cited by 23 publications

(18 citation statements)

References 24 publications

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“…Lactate performed well in risk assessment studies in septic patients; the cut-off values (2 and 4 mmol/L) were quite similar in different reports 12 14 15. Even in children with pneumonia, the risk classification performance of lactate was still reasonably accurate 16. Previous studies have proved the usefulness of lactate in prognosis and risk stratification, but few have investigated its performance in site-of-care decisions in adult pneumonia patients in the ED.…”

Section: Introductionmentioning

confidence: 54%

“…In a study conducted in an infectious cohort in the ED, patients with serum lactate of 4 mmol/L or greater had a 3-day mortality rate of 22.4% compared with 1.5% in patients with a serum lactate of 2.4 mmol/L or less 19. A recent study showed that lactate was a robust predictor of death in children with CAP 16. However, studies in adult pneumonia patients are still rare.…”

Section: Discussionmentioning

confidence: 99%

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Lactate on emergency department arrival as a predictor of mortality and site-of-care in pneumonia patients: a cohort study

Chen

2015

Thorax

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Section: Introductionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Lactate on emergency department arrival as a predictor of mortality and site-of-care in pneumonia patients: a cohort study

Chen

2015

Thorax

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“…In the absence of controlled studies demonstrating mortality reduction after bCPAP, the improvement of physiological parameters such as hypoxaemia, a predictor of mortality in children with pneumonia, 21,22 can serve as a proxy indicator for bCPAP effectiveness. In this study there were physiological benefits from bCPAP in a group of children with acute respiratory failure and a high prevalence of HIV: respiratory rates, oxygen saturation and respiratory effort all improved in the hours following initiation of bCPAP.…”

Section: Discussionmentioning

confidence: 99%

Non-invasive ventilation with bubble CPAP is feasible and improves respiratory physiology in hospitalised Malawian children with acute respiratory failure

Walk

Dinga

Banda

et al. 2014

Paediatrics and International Child Health

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Background In low-income countries and those with a high prevalence of HIV, respiratory failure is a common cause of death in children. However, the role of non-invasive ventilation with bubble continuous positive airway pressure (bCPAP) in these patients is not well established. Methods A prospective observational study of bCPAP was undertaken between July and September 2012 in 77 Malawian children aged 1 week to 14 years with progressive acute respiratory failure despite oxygen and antimicrobial therapy. Results Forty-one (53%) patients survived following bCPAP treatment, and an HIV-uninfected single-organ disease subgroup demonstrated bCPAP success in 14 of 17 (82%). Compared with children aged ≥60 months, infants of 0–2 months had a 93% lower odds of bCPAP failure (odds ratio 0.07, 95% confidence interval 0.004–1.02, P = 0.05). Following commencement of bCPAP, respiratory physiology improved, the average respiratory rate decreased from 61 to 49 breaths/minute (P = 0.0006), and mean oxygen saturation increased from 92.1% to 96.1% (P = 0.02). Conclusions bCPAP was well accepted by caregivers and patients and can be feasibly implemented into a tertiary African hospital with high-risk patients and limited resources.

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“…Despite the publication of a few studies that investigated the association of admission hyperlactatemia with mortality in the pediatric population [6,8-16], information on its importance in a general population of critically ill children is limited [9,14,15]. The predictive value of a single lactate level assessed at admission, unlike serial measurements of lactate, is controversial in the general population of critically ill children [9,14,15].…”

Section: Introductionmentioning

confidence: 99%

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

Bai

Zhu

et al. 2014

BMC Pediatr

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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.

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Lactate as a predictor of mortality in Malawian children with WHO-defined pneumonia

Abstract: Used in conjunction with clinical risk factors and pulse oximetry for measuring oxygen saturation, lactate could play an important role in identifying the sickest patients with pneumonia in developing countries.

Cited by 23 publications

References 24 publications

Lactate on emergency department arrival as a predictor of mortality and site-of-care in pneumonia patients: a cohort study

Lactate on emergency department arrival as a predictor of mortality and site-of-care in pneumonia patients: a cohort study

Non-invasive ventilation with bubble CPAP is feasible and improves respiratory physiology in hospitalised Malawian children with acute respiratory failure

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

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