Serum lactate levels as the predictor of outcome in pediatric septic shock

Abstract

Background and Aims:An association of high lactate levels with mortality has been found in adult patients with septic shock. However, there is controversial literature regarding the same in children. The aim of this study was to find the correlation of serum lactate levels in pediatric septic shock with survival.Settings and Design:This was a prospective observational study at PICU of a tertiary care center of North India.Materials and Methods:A total of 30 children admitted to PICU with diagnosis of septic shock were included in the study. PRISM III score and demographic characteristics of all children were recorded. Serum lactate levels were measured in arterial blood at 0-3, 12, and 24 h of PICU admission. The outcome (survival or death) was correlated with serum lactate levels.Results:Septic shock was the most common (79.3%) type of shock and had 50% mortality. Initial as well as subsequent lactate levels were significantly higher in nonsurvivors. A lactate value of more than 45 mg/dl (5 mmol/l) at 0–3, 12, and 24 h of PICU admission had an odds ratio for death of 6.7, 12.5, and 8.6 (95% CI: 1.044–42.431, 1.850–84.442, 1.241–61.683) with a positive predictive value (PPV) of 38%, 71%, 64% and a negative predictive value (NPV) of 80%, 83%, and 83%, respectively.Conclusions:Nonsurvivors had higher blood lactate levels at admission as well as at 12 and 24 h. A lactate value of more than 45 mg/dl (5 mmol/l) was a good predictor of death.

Association between vasoactive-inotropic score and mortality in pediatric septic shock

“…Jat, et al [1] also reported similar mortality rate (50%) in their cohort of children with septic shock. The vasoactive-inotrope score (VIS) is a simple, clinical tool, easy to use, and based on bedside hemodynamic parameter to monitor cardiovascular support in critically ill child with septic shock.…”

“…Multiple factors have been identified as a predictor for poor outcome of septic shock among children [1,5]. Kutko, et al [5] in their retrospective review of children with septic shock found that the high mortality rate was associated with the presence of multiorgan dysfunction syndrome.…”

“…Kutko, et al [5] in their retrospective review of children with septic shock found that the high mortality rate was associated with the presence of multiorgan dysfunction syndrome. Several studies have shown that high serum lactate is another predictor of poor outcome in children with septic shock [1,2]. A recent guideline on pediatric sepsis from American College of Critical Care Medicine (ACCM) has cautioned against monitoring of serum lactate in children with septic shock, as epinephrine infusion is known to increase plasma lactate concentration independent of changes in organ perfusion [6].…”

“…The mortality in pediatric septic shock is associated with lactic acidosis and presence of multiorgan dysfunction syndrome [1,2]. Inotrope and vasoactive agents are routinely employed in children with septic shock to maintain cardiovascular support for oxygen delivery and tissue perfusion.…”

Evaluation Of The Lactate significance In The Neonatal Intensive Care

“…Более высо-кую прогностическую точку демонстрирует работа, в которой уровни лактата выше 10 ммоль/л и насы-щение кислорода в венозной крови (SvO 2 , %) меньше 50 % связаны с развитием полиорганной недостаточ-ности [18]. В исследовательских работах показано наличие корреляции лактата с оценками по шкалам тяжести состояния и исхода [1, 4,6,[11][12][13][14][15]. Таким образом, место и значимость маркера лактата как в диагностическом, так и в прогностическом аспек-тах окончательно не определено.…”