Evaluating lactate prognostic value in children suspected of acetaminophen-induced liver failure in Liberia

Area of Science:

• Pediatric Hepatology
• Toxicology
• Critical Care Medicine

Background:

• Acetaminophen (paracetamol) overdose is a common cause of acute liver injury in children.
• The prognostic value of hyperlactatemia in pediatric acetaminophen-induced liver injury (AILI) is not well-established.
• Early identification of high-risk pediatric patients is crucial for timely intervention.

Purpose of the Study:

• To investigate the prognostic significance of hyperlactatemia in young children with liver injury.
• To determine the optimal lactate threshold for predicting mortality in pediatric acetaminophen toxicity.
• To evaluate the utility of existing lactate thresholds in this specific population.

Main Methods:

• Retrospective medical chart review of children under 5 years old admitted with hepatocellular injury.
• Inclusion of patients with available blood lactate measurements on admission.
• Analysis of mortality rates, acetaminophen concentrations, and lactate levels.

Main Results:

• A total of 95 children were analyzed; 52% died during hospitalization.
• Children who died had significantly higher median lactate levels (10.7 mmol/L) compared to survivors (6.1 mmol/L).
• An optimal lactate threshold of 7.2 mmol/L predicted non-survival with 84% sensitivity and 70% specificity (AUC=0.80).

Conclusions:

• Hyperlactatemia is a significant predictor of mortality in pediatric acetaminophen-induced liver injury.
• A venous blood lactate concentration exceeding 7.2 mmol/L indicates a poor prognosis in young children with suspected acetaminophen toxicity.
• Established lactate thresholds (3.5-4 mmol/L) are insufficient for identifying non-survival in this pediatric cohort.