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Lactate dynamics in paediatric patients with severe sepsis: insights from a prospective cohort study

Tarek A Abdelaziz1, Nehad Ahmed Karam2, Weaam Ibrahim Ismail3

  • 1Paediatric Department, Faculty of Medicine, Zagazig University, Zagazig city, Egypt. tareklatef43@gmail.com.

BMC Pediatrics
|May 17, 2024
PubMed

Insights

Monitoring lactate levels in children with severe sepsis is crucial. Higher lactate levels and lower clearance rates six hours after admission significantly predict mortality in pediatric intensive care units.

Area of Science:

  • Pediatric critical care medicine
  • Infectious diseases
  • Biomarkers and diagnostics

Background:

  • Sepsis, a life-threatening organ dysfunction caused by infection, is associated with elevated lactate levels.
  • Lactate monitoring is critical for managing severe sepsis and improving patient outcomes.
  • Pediatric severe sepsis and septic shock require effective prognostic indicators.

Purpose of the Study:

  • To evaluate the association between plasma lactate levels and mortality in pediatric patients with severe sepsis or septic shock.
  • To determine the predictive value of initial and 6-hour lactate measurements and lactate clearance for mortality.
  • To identify optimal cut-off values for lactate levels and clearance in predicting pediatric intensive care unit (PICU) mortality.

Main Methods:

  • Prospective study in a pediatric intensive care unit (PICU) using International Paediatric Sepsis Consensus Conference criteria.
  • Measurement of plasma lactate levels at admission (Lac H0) and 6 hours later (Lac H6).
  • Calculation of static indices (Lac H0, Lac H6) and dynamic indices (delta-lactate, 6-hour lactate clearance).

Main Results:

  • The study included 46 children; the overall mortality rate was 54.3%.
  • Initial lactate levels (Lac H0) did not differ between survivors and non-survivors.
  • Survivors showed significantly lower Lac H6, higher delta-lactate, and higher 6-hour lactate clearance rates compared to non-survivors.
  • Lactate clearance rates below 10% and Lac H6 levels ≥ 4 mmol/L were significantly associated with increased PICU mortality.

Conclusions:

  • Lactate level trends over time are significant predictors of mortality in pediatric severe sepsis and septic shock.
  • Elevated lactate levels and diminished lactate clearance at 6 hours post-hospitalization are linked to higher mortality rates.
  • Dynamic lactate monitoring provides valuable prognostic information in critically ill children with sepsis.
Abstract

Keywords:
ClearanceDelta-lactateKineticsLac H0Lac H6LactateMortalitySepsisShock

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