Lactic acid level as an outcome predictor in pediatric patients with intussusception in the emergency department

Abstract

Background: Intussusception decreases blood flow to the bowel, and tissue hypoperfusion results in increased lactic acid levels. We aimed to determine whether lactic acid levels are associated with pediatric intussusception outcomes. Methods: The electronic medical records of our emergency department pediatric patients diagnosed with intussusception, between January 2015 and October 2018, were reviewed. An outcome was considered poor when intussusception recurred within 48 h of reduction or when surgical reduction was required due to air enema failure. Results: A total of 249 patients were included in the study, including 39 who experienced intussusception recurrence and 11 who required surgical reductions; hence, 50 patients were included in the poor outcome group. The poor and good outcome groups showed significant differences in their respective blood gas analyses for pH (7.39 vs. 7.41, P = .001), lactic acid (1.70 vs. 1.30 mmol/L, P < .001), and bicarbonate (20.70 vs. 21.80 mmol/L, P = .036). Multivariable logistic regression analyses showed that pH and lactic acid levels were the two factors significantly associated with poor outcomes. When the lactic acid level cutoff values were ≥ 1.5, ≥2.0, ≥2.5, and ≥ 3.0 mmol/L, the positive predictive values for poor outcomes were 30.0, 34.6, 50.0, and 88.9%, respectively. Conclusion: Lactic acid levels affect outcomes in pediatric patients with intussusception; higher lactic acid levels are associated with higher positive predictive values for poor outcomes.

Decreased Incidence of Pediatric Intussusception during COVID-19

“…Indeed, differences were found in the serum lactate levels and base excess, which are possible markers of organ failure, in patients assessed before and after the COVID-19 outbreak. In particular, high serum lactate levels have been associated with poor outcomes of intussusception [26]. Although air enema reduction was delayed for about 0.5 h in patients who visited during the pandemic period, the duration of illness in these patients was similar to that in patients who visited during the pre-pandemic period.…”

“…The COVID-19 pandemic resulted in patient reluctance to visit the emergency department (ED) [19,20], which can delay various surgical emergencies and can worsen their clinical courses [21][22][23]. Especially in intussusception, the most common surgical emergency in young children, a delay in visiting the ED and in intervention can increase the risks of surgical reduction and poor outcomes [24][25][26][27]. Therefore, this study assessed the changes in the incidence and clinical characteristics of intussusception between the pre-pandemic and COVID-19 pandemic periods.…”

Correlation Analysis of Lactic Acid Level as A Predictor of Severity of Patients with Acute Appendicitis

“…The result was that patients who received intravenous fluids before 30 minutes had a 12% shorter length of stay compared to patients who received intravenous fluids after 30 minutes (HR 1.14; 95% CI, 1.02-1.27). 4,8,9 This study has several limitations that might have an influence on the results of this study which showed a negative correlation between lactic acid levels and the incidence of perforated appendicitis. This study had a sample size that was less than the minimum number of samples because the study was conducted in a type A general hospital (main referral hospital) where cases of acute appendicitis were rare.…”

A comprehensive scoring system for the better prediction of bowel resection in pediatric intussusception

“…Intussusception is a common cause of bowel resection in infants and young children [ 7 , 8 ]. It is well-established that prompt identification and management are crucial for reducing the incidence of intestinal necrosis resulting from intussusception.…”