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Serum lactate levels as the predictor of outcome in pediatric septic shock
Kana Ram Jat1, Urmila Jhamb, Vinod K Gupta
1Department of Pediatrics, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India.
Insights
High serum lactate levels in children with septic shock are linked to increased mortality. A lactate level exceeding 45 mg/dl at 0-3, 12, or 24 hours significantly predicts death in pediatric septic shock patients.
Area of Science:
- Pediatric Critical Care Medicine
- Septic Shock Pathophysiology
- Biomarker Research
Background:
- Septic shock carries high mortality in children.
- Lactate levels are established mortality predictors in adult septic shock.
- Evidence linking pediatric septic shock lactate levels to outcomes is controversial.
Purpose of the Study:
- To investigate the correlation between serum lactate levels and survival in pediatric septic shock.
- To determine if lactate levels can predict mortality in pediatric septic shock.
Main Methods:
- Prospective observational study conducted in a North Indian tertiary care pediatric intensive care unit (PICU).
- Included 30 pediatric septic shock patients, recording PRISM III scores and demographics.
- Measured serum lactate levels at 0-3, 12, and 24 hours post-PICU admission; correlated with survival outcomes.
Main Results:
- Septic shock accounted for 79.3% of shock cases, with a 50% mortality rate.
- Nonsurvivors exhibited significantly higher initial and subsequent serum lactate levels.
- Lactate >45 mg/dl (5 mmol/l) at 0-3, 12, and 24 hours showed high odds ratios for death (6.7, 12.5, 8.6 respectively) and good predictive values.
Conclusions:
- Elevated serum lactate levels at admission and during PICU stay are associated with mortality in pediatric septic shock.
- Serum lactate >45 mg/dl (5 mmol/l) serves as a significant predictor of death in this population.
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.