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Can Lactate Clearance Predict Mortality in Critically Ill Children?
Azza A Moustafa1, Abeer S Elhadidi2, Mona A El-Nagar1
1Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Insights
Serial lactate clearance after 6 hours in the pediatric intensive care unit (PICU) predicts mortality in critically ill children. Improved lactate clearance indicates better survival outcomes, unlike initial lactate levels.
Area of Science:
- Pediatric Critical Care Medicine
- Biomarkers in Critical Illness
- Lactate Kinetics
Background:
- Single blood lactate measurements have limited prognostic value in critically ill children.
- Serial lactate monitoring, particularly lactate clearance, may offer superior predictive capabilities.
Purpose of the Study:
- To assess the efficacy of 6-hour lactate clearance post-PICU admission as a mortality predictor in critically ill children.
- To compare the prognostic significance of initial lactate levels versus 6-hour lactate clearance.
Main Methods:
- A prospective observational study involving 76 critically ill children in a pediatric intensive care unit (PICU).
- Arterial blood lactate levels were measured at admission and 6 hours later.
- Lactate clearance was calculated, and patients were stratified into groups based on clearance (positive vs. non-positive).
- Statistical analyses included ROC curves, Kaplan-Meier survival analysis, and multivariate logistic regression.
Main Results:
- Initial lactate levels were a poor predictor of mortality (AUC = 0.519).
- Lactate clearance after 6 hours significantly predicted mortality (AUC = 0.766, p < 0.001).
- Patients with positive lactate clearance demonstrated significantly better survival (p < 0.001).
- Both 6-hour lactate clearance (OR = 0.98) and the Pediatric Index of Mortality 2 (PIM2) score (OR = 4.7) were independent predictors of mortality.
Conclusions:
- Lactate clearance after 6 hours of PICU admission is a valuable and independent predictor of mortality in critically ill children.
- Serial lactate assessment offers greater prognostic insight than single measurements in this population.
Abstract:
Serial evaluation of blood lactate, including lactate clearance, may have greater value over single measurement at the time of presentation. The rationale of the current study was to evaluate the use of lactate clearance after 6 hours of admission to pediatric intensive care unit (PICU) as a predictor of mortality in critically ill children. A prospective observational study was conducted in a nine-bed PICU of a tertiary care teaching hospital over a period of 6 months. Lactate levels were measured in arterial blood samples of 76 patients at the time of admission and 6 hours later. According to calculated lactate clearance, patients were divided into group A (lactate clearance more than 0) which included 71% of patients and group B (lactate clearance ≤0) which included 29% of patients. Lactate level at admission was a poor predictor of mortality (area under receiver operating characteristic curve [AUC] = 0.519, p = 0.789). Lactate clearance after 6 hours of admission was a significant predictor of mortality (AUC = 0.766, p < 0.001). Using Kaplan-Meier survival curve, overall survival was significantly better among group A ( p < 0.001). Using multivariate logistic regression model, lactate clearance after 6 hours (odds ratio = 0.98, 95% confidence interval [CI]: 0.96-0.99) and The Pediatric Index of Mortality 2 (PIM2) score (odds ratio = 4.7, 95% CI: 1.85-12.28) had independent prognostic significance with regard to mortality ( p = 0.030, 0.001 respectively). We conclude that lactate clearance after 6 hours of admission can predict mortality in critically ill children.
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