The prognostic value of delta-lactate in critically ill children

Area of Science:

• Pediatric Critical Care Medicine
• Biomarker Research
• Clinical Risk Stratification

Background:

• Lactate levels are crucial indicators in critically ill patients.
• Short-term risk stratification is essential for timely intervention in pediatric intensive care units (PICUs).
• Existing methods may not fully capture dynamic changes in lactate for predicting outcomes.

Purpose of the Study:

• To evaluate delta-lactate (ΔL) as a short-term risk stratification tool in critically ill children.
• To determine the predictive value of ΔL for mortality within the PICU and at 28 days.
• To establish a ΔL cutoff for differentiating between low and high mortality risk groups.

Main Methods:

• An exploratory study involving patients admitted to a pediatric intensive care unit (PICU).
• Delta-lactate (ΔL) was calculated as the difference between maximum lactate concentrations on Day 1 and Day 2.
• Patients were categorized into low mortality risk (LMR) and high mortality risk (HMR) groups based on a ΔL cutoff of 0.05 mmol/L.

Main Results:

• Mortality during PICU stay and at 28 days was associated with elevated serum lactate on Days 1 and 2.
• For patients with elevated Day 1 lactate, the ΔL cutoff of 0.05 mmol/L showed an area under the ROC curve of 0.698.
• High mortality risk (HMR) patients had higher PIM3 scores, longer PICU stays, fewer ventilation-free days, and increased need for renal replacement therapy.

Conclusions:

• Elevated lactate levels on admission and the ΔL cutoff can predict short-term mortality in critically ill children.
• An increase or minimal decrease in maximum lactate levels from Day 1 to Day 2 was associated with an almost eightfold increase in the probability of death.
• Delta-lactate serves as a valuable predictor of short-term outcomes in the pediatric intensive care setting.