Lactate clearance and mortality in pediatric sepsis

Saputra, Dedi Kurniawan; Runtunuwu, Ari L.; Tatura, Suryadi N. N.; Manoppo, Jeanette I. Ch.; Lolombulan, Julius H.

doi:10.14238/pi56.4.2016.215-20

Cited by 8 publications

(11 citation statements)

References 15 publications

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“…Similar to the present study, several authors postulated LacCl% to be higher in survivor children. 5,15,24 Others have found ΔLac to be an independent predictor of hospital mortality in adults 17,28 and postoperative serious adverse events in children. 29…”

Section: Discussionmentioning

confidence: 99%

“…14 LacCl% at the cutoff point of 30% to 34.7% resulted in greater sensitivity (75%-87.50%), specificity (96.5%-97%), PPV (90%-93.3%), and NPV (91.4%-93.3%) in other studies. 15,36…”

Section: Discussionmentioning

confidence: 99%

“…Similar to the present study, several authors postulated LacCl% to be higher in survivor children. 5,15,24 Others have found DLac to be an independent predictor of hospital mortality in adults 17,28 and postoperative serious adverse events in children. 29 In the present study, children requiring vasopressors and mechanical ventilation had higher Lac0, Lac6, LacTW, and lower LacCl% than those that did not.…”

Section: Discussionmentioning

confidence: 99%

“…Although available evidence indicates that static lactate indices (lactate at admission) are correlated with intensive care unit (ICU) 13 and hospital mortality, 14 a dynamic measure of lactate clearance may be better associated with mortality in ICU 15 and emergency department (ED) 16 settings, although no consensus on the degree or timeframe exists.…”

Section: Introductionmentioning

confidence: 99%

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Lactate Measurements and Their Association With Mortality in Pediatric Severe Sepsis in India: Evidence That 6-Hour Level Performs Best

Alam

Gupta

2020

J Intensive Care Med

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Purpose: To investigate association of static and dynamic lactate indices with early mortality (within 48 hours of admission), as well as need for vasopressors and mechanical ventilation in pediatric severe sepsis/shock. To explore optimal cutoffs of lactate indices. We hypothesized that dynamic indices are superior to static indices in predicting early mortality. Methods: This prospective cohort study involved children (aged <14 years) admitted in emergency department, tertiary care teaching hospital in North India with severe sepsis/shock (2015-2016). Arterial lactate was measured at admission (X0) and after 6 hours (X6). Primary outcome of the measurement was early mortality. Association between lactate indices— lactate at 0 hours (Lac0), lactate after 6 hours (Lac6), time-weighted average (LacTW), delta (ΔLac), clearance (LacCl%) and early mortality, need for vasopressors, and mechanical ventilation—was assessed using Student t test/Mann-Whitney test. Area under the receiver operating characteristic curve (AUROC) for early mortality deduced for all lactate indices and compared with reference (Lac0). Optimal cutoffs (maximizing both sensitivity and specificity) and their positive predictive value (PPV) and negative predictive value (NPV) were determined. Results: During the study period, 116 children were assessed. Septic shock was present at admission in 56.9% children; 50% of children died during the next 48 hours. Lac0, Lac6, and LacTW were significantly higher, and LacCl% was lower in nonsurvivors versus survivors (all P < .001). Lac6 (0.837 [0.76-0.91]) had significantly higher AUROC (95% confidence interval) than Lac0 (0.77; P = .03). Abnormal lactate metrics (higher Lac0, Lac6, LacTW, and lower LacCl%) were associated with vasopressors need and mechanical ventilation. On logistic regression, Lac6 emerged as an independent predictor of early mortality as well as vasopressor and mechanical ventilation need. The optimal cutoff of Lac6 for identifying early mortality with good sensitivity, specificity, PPV, and NPV was ≥2.65 (76, 85, 83, 78). Conclusions: Lactate6 is the best marker associated with early mortality and higher level of care in severe sepsis/septic shock in resource-poor regions.

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Section: Discussionmentioning

confidence: 99%

“…14 LacCl% at the cutoff point of 30% to 34.7% resulted in greater sensitivity (75%-87.50%), specificity (96.5%-97%), PPV (90%-93.3%), and NPV (91.4%-93.3%) in other studies. 15,36…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Lactate Measurements and Their Association With Mortality in Pediatric Severe Sepsis in India: Evidence That 6-Hour Level Performs Best

Alam

Gupta

2020

J Intensive Care Med

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“…A number of studies demonstrated that the ability to clear lactate to normal in patients suffering from septic shock was associated with an improved outcome, those authors coined the term "lactate clearance". 20 On the other hand, the value of albumin levels in predicting outcomes in inflammatory diseases is also well known. Artero et al 21 found that in patients with community-acquired blood stream infections, with severe sepsis or septic shock, hypoalbuminemia is the strongest predictor of mortality.…”

Section: Discussionmentioning

confidence: 99%

Association of lactate/albumin ratio level to organ failure and mortality in severe sepsis in a pediatric intensive care unit in Egypt

et al. 2018

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Moustafa AA, Antonios MAM, Abdellatif EM, Hussain AH. Association of lactate/albumin ratio level to organ failure and mortality in severe sepsis in a pediatric intensive care unit in Egypt. Turk J Pediatr 2018; 60: 691-701.This study aimed at investigating the lactate to albumin ratio, as a newly introduced biomarker of multiple organ dysfunction syndrome (MODS) and mortality compared to the classic lactate clearance in pediatric patients. We designed a prospective cohort study and 155 patients with severe sepsis or septic shock admitted to a Pediatric Intensive Care Unit were included, starting from January 2016 to March 2017. The data of 119 patients who completed the study, were analyzed. Results revealed that lactate clearance (6h, 24h) was significantly lower and lactate/albumin ratio (0h, 6h, 24h) was significantly higher in patients who developed MODS and in those who passed away. The univariate logistic regression showed that both lactate clearance and lactate/albumin ratio were significant prognostic factors of MODS and mortality. According to the AUC, lactate/albumin ratio (0h, 6h, 24h) showed better discrimination of MODS development (with AUC of 0.729, 0.814, and 0.819, respectively) compared to lactate clearance (6h, 24h; AUC of 0.738, and 0.672, respectively). Again the lactate/albumin ratio (0h, 6h, 24h) showed better discriminatory power of mortality (0.681, 0.741, and 0.856, respectively) compared to the lactate clearance (6h, 24h; 0.638 and 0.77, respectively). The Youden Index specified a lactate/albumin ratio (0h, 6h, 24h) of 1.17, 1.07, and 1.1 to be the cut-off discriminating values, respectively. The Kaplan-Meier curves revealed that the cumulative of survival is significantly better for the group of patients with a lactate/albumin ratio less than the cut-off values. It was concluded that lactate/albumin ratio is a better discriminator of MODS development and mortality than lactate clearance in pediatric patients with severe sepsis or septic shock.

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Assessment of Tissue Perfusion Using the Peripheral Perfusion Index and Lactate Clearance in Shock in Pediatric Patients

Bazaraa

Roby

Salah

et al. 2021

Shock

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Background: Pediatric shock has a high mortality rate because many of the early clinical signs are subtle and have poor sensitivity and specificity. Pediatric shock was categorized either: compensated with normal blood pressure, poor skin perfusion (CRT >2 s, mottled, cool peripheries, peripheral cyanosis), weak peripheral pulse, age specific tachycardia, tachypnoea, and oliguria or decompensated with hypotension (SBP < 70 þ (2Â age in years) mm Hg and decreased mental status. The perfusion index is a non-invasive method for assessing peripheral perfusion and may be a useful marker for identifying shock early in pediatric patients. Objective: This prospective cohort study (November 2019 to August 2020) evaluated whether the perfusion index, lactate, and/or lactate clearance could predict mortality among pediatric shock patients. Methods: Fifty children (68% male) with shock underwent assessments at presentation to the emergency room to evaluate their heart rate, blood pressure, capillary refill time, central venous pressure, perfusion index, cardiac index, systemic vascular resistance, central venous oxygen saturation, and lactate clearance. Results: The perfusion index range was 0.03 to 2.2 and 0.18 as the cut-off for mortality prediction providing 74% sensitivity and 78% specificity. The serum lactate concentration range was 0 to 16 mmol/L and >5.7 mmol/L as the cut-off for mortality prediction provided 70% sensitivity and 96% specificity at presentation to the emergency room. The lactate clearance range was 3% to 75% and >10% as the cut-off for survival prediction after resuscitation and at 6 h later. Conclusion: Perfusion index (PI), lactate, and lactate clearance provided comparable sensitivity and specificity for predicting outcomes among pediatric patients with shock Therefore, we suggest that the PI is an inexpensive, rapid, and non-invasive tool that can be used to predict illness severity and mortality in busy pediatric intensive care units and emergency departments. This tool may guide better patient triage and an earlier diagnosis of shock in this setting.

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Lactate clearance and mortality in pediatric sepsis

Abstract: Background Sepsis is a life-threatening condition often

Cited by 8 publications

References 15 publications

Lactate Measurements and Their Association With Mortality in Pediatric Severe Sepsis in India: Evidence That 6-Hour Level Performs Best

Lactate Measurements and Their Association With Mortality in Pediatric Severe Sepsis in India: Evidence That 6-Hour Level Performs Best

Association of lactate/albumin ratio level to organ failure and mortality in severe sepsis in a pediatric intensive care unit in Egypt

Assessment of Tissue Perfusion Using the Peripheral Perfusion Index and Lactate Clearance in Shock in Pediatric Patients

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