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Validation of lactate clearance at 6 h for mortality prediction in critically ill children
1Department of Pediatrics, St. Stephen's Hospital, New Delhi, India.
Insights
Lactate clearance (LC) at 6 hours in pediatric intensive care unit (PICU) patients is a valuable tool for predicting mortality. A cutoff of <16.435% indicates high mortality risk, outperforming the Pediatric Index of Mortality 2 score.
Area of Science:
- Pediatric Critical Care Medicine
- Biomarkers in Critical Illness
- Mortality Prediction Models
Background:
- Lactate clearance (LC) is increasingly recognized as a marker of tissue hypoperfusion in critically ill patients.
- Validating LC at 6 hours for mortality prediction in the Pediatric Intensive Care Unit (PICU) is crucial for early intervention.
- Comparison with existing scoring systems like the Pediatric Index of Mortality 2 (PIM 2) is needed to establish its clinical utility.
Purpose of the Study:
- To validate the 6-hour lactate clearance (LC) for predicting in-hospital mortality in pediatric intensive care unit (PICU) patients.
- To compare the predictive accuracy of 6-hour LC with the Pediatric Index of Mortality 2 (PIM 2) score.
- To determine an optimal LC cut-off value for identifying high-risk pediatric patients.
Main Methods:
- A prospective, observational study was conducted in a tertiary care center.
- 140 children under 13 years admitted to the PICU had lactate levels measured at 0 and 6 hours.
- In-hospital mortality was compared between patients with and without significant LC, and correlated with PIM 2 scores.
Main Results:
- A 6-hour LC cut-off of <16.435% was associated with significantly higher in-hospital mortality (39.6%) compared to the clearance group (4.3%, P=0.000).
- The 6-hour LC demonstrated good predictive performance (AUC=0.823), with sensitivity of 82.6% and specificity of 75.2%.
- The PIM 2 score showed a higher area under the ROC curve (0.906) but mean PIM 2 scores were significantly higher in the delayed/non-LC group.
Conclusions:
- A 6-hour lactate clearance of less than 16.435% is a significant predictor of high mortality in PICU patients.
- Lactate clearance at 6 hours is a valuable, readily available tool for early risk stratification in critically ill children.
- While PIM 2 is a robust predictor, 6-hour LC offers a complementary and dynamic assessment of patient status.
Background And Aims:
To validate the lactate clearance (LC) at 6 h for mortality prediction in Pediatric Intensive Care Unit (PICU)-admitted patients and its comparison with a pediatric index of mortality 2 (PIM 2) score.
Design:
A prospective, observational study in a tertiary care center.
Materials And Methods:
Children <13 years of age, admitted to PICU were included in the study. Lactate levels were measured at 0 and 6 h of admission for clearance. LC and delayed or nonclearance group compared for in-hospital mortality and compared with PIM 2 score for mortality prediction.
Results:
Of the 140 children (mean age 33.42 months) who were admitted to PICU, 23 (16.42%) patients died. For LC cut-off (16.435%) at 6 h, 92 patients qualified for clearance and 48 for delayed or non-LC group. High mortality was observed (39.6%) in delayed or non-LC group as compared to clearance group (4.3%) (P = 0.000). LC cut-off of 16.435% at 6 h (sensitivity 82.6%, specificity 75.2%, positive predictive value 39.6%, and negative predictive value 95.7%) correlates with mortality. Area under receiver operating characteristic (ROC) for LC at 6 h for mortality prediction was 0.823 (P = 0.000). The area under ROC curve for expected mortality prediction by PIM 2 score at admission was 0.906 and at 12.3% cut-off of PIM 2 Score was related with mortality. The mean PIM 2 score was high in delayed or non-LC group (25.25%) compared to LC group (10.95%) (P = 0.004).
Conclusion:
LC cut-off <16.435% at 6 h was associated with high mortality.
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