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Lactate as a predictor of mortality in Malawian children with WHO-defined pneumonia
Bharat Ramakrishna1, Stephen M Graham, Ajib Phiri
1Centre for International Child Health, University of Melbourne, Department of Paediatrics, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia.
Insights
Blood lactate levels at hospital admission can predict mortality in children with pneumonia. High lactate concentrations, along with hypoxemia and young age, are key risk factors for death.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Pneumonia is a leading cause of childhood mortality in developing countries.
- Identifying children at high risk of death is crucial for timely intervention.
- Blood lactate is a potential biomarker for assessing severity in pediatric infections.
Purpose of the Study:
- To evaluate blood lactate as a predictor of outcome in pediatric pneumonia in Malawi.
- To identify factors associated with elevated blood lactate levels in children with pneumonia.
Main Methods:
- Prospective study analyzing data from children with severe or very severe pneumonia.
- Measured serum lactate concentrations at hospital presentation.
- Utilized multivariable analysis to identify independent risk factors for mortality.
Main Results:
- Among 233 children, 92% of deaths (23/25) occurred in those with lactate >2.0 mmol/l.
- Lactate levels >4.0 mmol/l were associated with higher mortality rates (18%).
- Independent risk factors for death included hypoxemia, hyperlactataemia, and age ≤12 months.
Conclusions:
- Blood lactate measurement can aid in identifying critically ill children with pneumonia.
- Lactate, combined with clinical assessment and pulse oximetry, improves risk stratification.
- This approach is valuable for resource-limited settings in developing countries.
Objectives:
To determine whether blood lactate measured at the time of presentation to hospital predicted outcome in children with pneumonia in Malawi, and to understand the factors associated with high blood lactate concentrations in pneumonia.
Design:
Analysis of data from a prospective study of children presenting to Queen Elizabeth Central Hospital, Blantyre, with WHO-defined severe or very severe pneumonia.
Results:
Among 233 children with pneumonia, the median serum lactate concentration was 2.7 mmol/l (IQR 1.8-4.4 mmol/l). 77 children (33%) had a lactate concentration of 2.1-4.0 mmol/l, and 72 children (31%) had a lactate concentration >4.0 mmol/l. 92% of children who died (23/25) had lactate >2.0 mmol/l at the time of admission to hospital. There were 10 deaths (13%) among 77 children who had a serum lactate concentration of 2.1-4.0 mmol/l; and 13 deaths (18%) in the 72 children who had lactate >4.0 mmol/l. The relative risk of death if the lactate level was above 2 mmol/l was 7.48 (1.72-32.6); sensitivity 0.92, specificity 0.39, positive predictive value 0.15, negative predictive value 0.98. Multivariable analysis showed that hypoxaemia, hyperlactataemia and age ≤12 months were independent risk factors for death from pneumonia.
Conclusions:
Used in conjunction with clinical risk factors and pulse oximetry for measuring oxygen saturation, lactate could play an important role in identifying the sickest patients with pneumonia in developing countries.
