Related Experiment Videos
Lactate clearance as the predictor of outcome in pediatric septic shock
Richa Choudhary1, Sadasivan Sitaraman1, Anita Choudhary1
1Department of Pediatrics, Sawai Man Singh Medical College, Sir Padampat Mother and Child Health Institute, Jaipur, Rajasthan, India.
Insights
Lactate clearance in children with septic shock predicts mortality. A 24-hour lactate clearance of less than 10% indicates a higher risk of in-hospital death.
Area of Science:
- Pediatric Critical Care Medicine
- Septic Shock Pathophysiology
- Biomarker Research
Background:
- Septic shock is a life-threatening condition leading to multiple organ failure.
- Hyperlactatemia is a recognized risk factor for mortality in critically ill patients.
- Early identification of high-risk pediatric septic shock patients is crucial.
Purpose of the Study:
- To assess the predictive capability of lactate clearance for outcomes in pediatric septic shock.
- To establish an optimal lactate clearance threshold for predicting mortality.
- To investigate the prognostic value of serial lactate measurements.
Main Methods:
- Prospective observational study in a pediatric Intensive Care Unit (PICU).
- Serial lactate level measurements at PICU admission, 24 hours, and 48 hours.
- Calculation of lactate clearance (percent decrease in 24 hours) and receiver operating characteristic (ROC) analysis for cut-off values.
Main Results:
- Nonsurvivors had significantly higher admission lactate levels (5.12 ± 3.51 mmol/L) than survivors (3.13 ± 1.71 mmol/L).
- An admission lactate level of ≥4 mmol/L predicted mortality (OR 5.4).
- Lactate clearance <10% at 24 hours predicted in-hospital mortality with 78.7% sensitivity and 72.2% specificity.
Conclusions:
- Serial lactate levels and clearance are valuable for predicting outcomes in pediatric septic shock.
- A 24-hour lactate clearance threshold of <10% is a significant predictor of in-hospital mortality.
- This finding aids in risk stratification and management of pediatric septic shock.
Context:
Septic shock can rapidly evolve into multiple system organ failure and death. In the recent years, hyperlactatemia has been found to be a risk factor for mortality in critically ill adults.
Aims:
To evaluate the predictive value of lactate clearance and to determine the optimal cut-off value for predicting outcome in children with septic shock.
Settings And Design:
A prospective observational study was performed on children with septic shock admitted to pediatric Intensive Care Unit (PICU).
Subjects And Methods:
Serial lactate levels were measured at PICU admission, 24 and 48 h later. Lactate clearance, percent decrease in lactate level in 24 h, was calculated. The primary outcome measure was survival or nonsurvival at the end of hospital stay. We performed receiver operating characteristic analyses to calculate optimal cut-off values.
Results:
The mean lactate levels at admission were significantly higher in the nonsurvivors than survivors, 5.12 ± 3.51 versus 3.13 ± 1.71 mmol/L (P = 0.0001). The cut-off for lactate level at admission for the best prediction of mortality was determined as ≥4 mmol/L (odds ratio 5.4; 95% confidence interval [CI] =2.45-12.09). Mean lactate clearance was significantly higher in survivors than nonsurvivors (17.9 ± 39.9 vs. -23.2 ± 62.7; P < 0.0001). A lactate clearance rate of <10% at 24 h had a sensitivity and specificity of 78.7% and 72.2%, respectively and a positive predictive value of 83.1% for death. Failure to achieve a lactate clearance of more than 10% was associated with greater risk of mortality (likelihood ratio + 2.83; 95% CI = 1.82-4.41).
Conclusions:
Serial lactate levels can be used to predict outcome in pediatric septic shock. A 24 h lactate clearance cut-off of <10% is a predictor of in-hospital mortality in such patients.