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Lactic acid level as an outcome predictor in pediatric patients with intussusception in the emergency department
Jeong-Yong Lee1, Young-Hoon Byun1, Jun-Sung Park1
1Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
Insights
Higher lactic acid levels in children with intussusception correlate with poorer outcomes. This finding suggests lactic acid can help predict the severity of pediatric intussusception.
Area of Science:
- Pediatric Gastroenterology
- Emergency Medicine
- Biochemistry
Background:
- Intussusception impairs bowel blood flow, leading to hypoperfusion and elevated lactic acid.
- Understanding the link between lactic acid and intussusception outcomes is crucial for pediatric care.
Purpose of the Study:
- To investigate the association between lactic acid levels and outcomes in pediatric intussusception.
- To determine if lactic acid can serve as a predictive marker for adverse outcomes in intussusception.
Main Methods:
- Retrospective review of electronic medical records for pediatric intussusception cases (January 2015 - October 2018).
- Defined poor outcomes as recurrence within 48 hours or need for surgical reduction.
- Analyzed blood gas data, including pH and lactic acid levels, comparing good and poor outcome groups.
Main Results:
- Significant differences in pH, lactic acid, and bicarbonate levels were observed between good and poor outcome groups.
- Multivariable logistic regression identified pH and lactic acid as significant predictors of poor outcomes.
- Higher lactic acid levels demonstrated increasing positive predictive values for poor outcomes, particularly at levels ≥2.5 mmol/L.
Conclusions:
- Lactic acid levels are a significant factor influencing outcomes in pediatric intussusception.
- Elevated lactic acid is associated with a higher likelihood of poor outcomes, including recurrence and surgical intervention.
- Lactic acid serves as a valuable prognostic indicator in pediatric intussusception management.
Background:
Intussusception decreases blood flow to the bowel, and tissue hypoperfusion results in increased lactic acid levels. We aimed to determine whether lactic acid levels are associated with pediatric intussusception outcomes.
Methods:
The electronic medical records of our emergency department pediatric patients diagnosed with intussusception, between January 2015 and October 2018, were reviewed. An outcome was considered poor when intussusception recurred within 48 h of reduction or when surgical reduction was required due to air enema failure.
Results:
A total of 249 patients were included in the study, including 39 who experienced intussusception recurrence and 11 who required surgical reductions; hence, 50 patients were included in the poor outcome group. The poor and good outcome groups showed significant differences in their respective blood gas analyses for pH (7.39 vs. 7.41, P = .001), lactic acid (1.70 vs. 1.30 mmol/L, P < .001), and bicarbonate (20.70 vs. 21.80 mmol/L, P = .036). Multivariable logistic regression analyses showed that pH and lactic acid levels were the two factors significantly associated with poor outcomes. When the lactic acid level cutoff values were ≥ 1.5, ≥2.0, ≥2.5, and ≥ 3.0 mmol/L, the positive predictive values for poor outcomes were 30.0, 34.6, 50.0, and 88.9%, respectively.
Conclusion:
Lactic acid levels affect outcomes in pediatric patients with intussusception; higher lactic acid levels are associated with higher positive predictive values for poor outcomes.
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