Admission serum lactate is associated with all-cause mortality in the pediatric intensive care unit
Chaoyan Yue1, Chunyi Zhang1, Chunmei Ying1
1Department of Laboratory Medicine, Obstetrics and Gynecology Hospital of Fudan University Shanghai, China.
Insights
Elevated serum lactate levels upon pediatric intensive care unit (ICU) admission are a significant risk factor for all-cause mortality. This finding holds true independently of other common critical illnesses in children.
Area of Science:
- Pediatric Critical Care Medicine
- Biomarkers in Critical Illness
- Clinical Epidemiology
Background:
- Serum lactate is a key indicator of tissue hypoperfusion and metabolic distress.
- Understanding predictors of mortality in pediatric intensive care units (PICUs) is crucial for improving patient outcomes.
- Previous studies have explored lactate's role, but its independent predictive value in diverse pediatric populations requires further clarification.
Purpose of the Study:
- To investigate the association between serum lactate levels at intensive care unit (ICU) admission and all-cause mortality in critically ill children.
- To determine if serum lactate is an independent predictor of mortality, irrespective of other clinical factors.
Main Methods:
- Retrospective analysis of 12,213 critically ill children from the Chinese Pediatric Intensive Care (PIC) database (2010-2018).
- Evaluation of serum lactate levels at ICU admission.
- Statistical analyses included adjusted smoothing spline plots, subgroup analysis, and segmented multivariate logistic regression to assess the risk of all-cause mortality.
Main Results:
- A total of 755 (6.18%) children died during the study period.
- Serum lactate level at ICU admission was identified as an independent risk factor for all-cause mortality (adjusted OR=1.14, 95% CI: 1.12, 1.17).
- Sensitivity analyses confirmed the stability of this association across different patient strata.
Conclusions:
- Admission serum lactate is a significant and independent risk factor for mortality in the pediatric intensive care unit.
- This association persists even when considering factors like acid-base disorders, inflammation, malnutrition, and renal or hepatic dysfunction.
- Serum lactate serves as a valuable prognostic biomarker in critically ill children.
Objective:
Our aim was to assess the relationship between serum lactate levels at intensive care unit (ICU) admission and all-cause mortality in the pediatric ICU.
Methods:
We used the pediatric intensive care (PIC) database (a large pediatric intensive care database in China from 2010 to 2018) to conduct a retrospective analysis to evaluate the serum lactate levels at ICU admission of 12,213 critically ill children admitted to the ICU. We analyzed the association between serum lactate and all-cause mortality. Adjusted smoothing spline plots, subgroup analysis, and segmented multivariate logistic regression analysis were conducted to estimate the relative risk between proportional risk between serum lactate and all-cause mortality.
Results:
Of the 12,213 children, 755 (6.18%) died. After fully adjusting for confounding factors, serum lactate was an independent risk factor for all-cause mortality in pediatric ICU (adjusted OR=1.14, 95% CI: 1.12, 1.17). The results of sensitivity analysis showed that in different stratified analyses, the effect of serum lactate on all-cause mortality remained stable.
Conclusions:
Admission serum lactate is a risk factor, which is independent of the presence of acid-base disorders, inflammation, malnutrition, and renal or hepatic dysfunction, for all-cause mortality in the pediatric intensive care unit.
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