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Related Experiment Videos

Early hyperlactataemia in critically ill children.

M Hatherill1, A G McIntyre, M Wattie

  • 1Paediatric Intensive Care Unit, Guy's Hospital, London, UK.

Intensive Care Medicine
|May 24, 2000
PubMed
Summary

Hyperlactataemia, or high blood lactate levels, in children admitted to intensive care is linked to increased mortality. Persistent high lactate after 24 hours or a higher peak lactate level can indicate a poorer outcome.

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Area of Science:

  • Pediatric Critical Care Medicine
  • Biochemistry
  • Clinical Pathology

Background:

  • Hyperlactataemia is a common finding in critically ill children.
  • The prognostic significance of hyperlactataemia, acidosis, and organ failure in pediatric intensive care remains an area of active research.

Purpose of the Study:

  • To investigate the association between early hyperlactataemia, acidosis, organ failure, and mortality in children admitted to the intensive care unit (ICU).

Main Methods:

  • A prospective observational study enrolled 50 children with hyperlactataemia (lactate > 2 mmol/l) admitted to the ICU, excluding post-operative patients and those with inherited metabolic diseases.
  • Data collected included Paediatric Risk of Mortality (PRISM) score, Multiorgan System Failure (MOSF) score, lactate levels, pH, and base excess (BE) up to 24 hours post-admission.

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  • Statistical analyses included Mann-Whitney, Fisher's Exact, Kruskal-Wallis, and chi-squared tests for trend.

    • Main Results:

    • Overall mortality in the screened population was 10%, while the hyperlactataemia group (n=50) had a 64% mortality rate.
    • Admission lactate, pH, and base excess did not significantly differ between survivors and nonsurvivors.
    • Peak lactate (P=0.02) and cumulative average lactate (P=0.0003) were significantly higher in nonsurvivors. Persistent hyperlactataemia at 24 hours was a strong predictor of mortality (likelihood ratio = 7).

    Conclusions:

    • Hyperlactataemia upon ICU admission is a significant indicator of high mortality risk in children.
    • Peak lactate levels and persistent hyperlactataemia after 24 hours are key indicators for identifying nonsurvivors among children with hyperlactataemia.