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Pediatric Malaria with Respiratory Distress: Prognostic Significance of Point-of-Care Lactate
Catherine Mitran1, Robert O Opoka2, Andrea L Conroy3
1Faculty of Medicine, University of Alberta, Edmonton, AB T6G 2R3, Canada.
Insights
In children with malaria and respiratory distress, high lactate levels at admission predict a significantly increased risk of death. Bedside lactate measurement can aid in identifying critically ill pediatric patients for prompt intervention.
Area of Science:
- Pediatric Infectious Diseases
- Critical Care Medicine
- Biomarker Discovery
Background:
- Respiratory distress (RD) in pediatric malaria is a critical indicator of poor prognosis.
- Lactic acidosis is recognized as a biomarker for severe disease in pediatric malaria.
- Predictive tools for mortality in children with malaria and RD are crucial for timely intervention.
Purpose of the Study:
- To investigate the predictive value of admission lactate levels for mortality in children hospitalized with malaria and RD.
- To assess the association between hyperlactatemia and mortality risk in this vulnerable pediatric population.
- To explore correlations between lactate levels and other clinical indicators of disease severity.
Main Methods:
- Pooled analysis of data from 1324 Ugandan children under five with malaria and RD from three previous studies.
- Lactate levels measured at admission using a handheld device.
- Mixed-effects Cox proportional hazard model used to analyze mortality risk associated with hyperlactatemia, adjusting for covariates.
Main Results:
- Hyperlactatemia (lactate > 5 mmol/L) was present in 44% of patients, with an overall mortality of 6.3%.
- Hyperlactatemia was independently associated with a 3-fold increased hazard of death (aHR 3.0, 95% CI 1.8-5.3).
- Higher lactate levels correlated with delayed capillary refill, hypotension, anemia, low tissue oxygen delivery, high parasite density, and acute kidney injury.
Conclusions:
- Bedside measurement of lactate at admission is a valuable tool for predicting mortality in children with malaria and respiratory distress.
- Hyperlactatemia serves as a significant independent predictor of death in this population.
- Lactate levels can assist in the triage and management of critically ill children with malaria and RD.
Abstract:
Respiratory distress (RD) in pediatric malaria portends a grave prognosis. Lactic acidosis is a biomarker of severe disease. We investigated whether lactate, measured at admission using a handheld device among children hospitalized with malaria and RD, was predictive of subsequent mortality. We performed a pooled analysis of Ugandan children under five years of age hospitalized with malaria and RD from three past studies. In total, 1324 children with malaria and RD (median age 1.4 years, 46% female) from 21 health facilities were included. Median lactate level at admission was 4.6 mmol/L (IQR 2.6-8.5) and 586 patients (44%) had hyperlactatemia (lactate > 5 mmol/L). The mortality was 84/1324 (6.3%). In a mixed-effects Cox proportional hazard model adjusting for age, sex, clinical severity score (fixed effects), study, and site (random effects), hyperlactatemia was associated with a 3-fold increased hazard of death (aHR 3.0, 95%CI 1.8-5.3, p < 0.0001). Delayed capillary refill time (τ = 0.14, p < 0.0001), hypotension (τ = -0.10, p = 0.00049), anemia (τ = -0.25, p < 0.0001), low tissue oxygen delivery (τ = -0.19, p < 0.0001), high parasite density (τ = 0.10, p < 0.0001), and acute kidney injury (p = 0.00047) were associated with higher lactate levels. In children with malaria and RD, bedside lactate may be a useful triage tool, predictive of mortality.
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