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Published on: June 28, 2018
Relationship between lactate levels and 28-day mortality in pediatric sepsis: results from the pediatric intensive
Yongfu Song1, Na Wang1, Xiaofei Xie1
1Department of Pediatrics, The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, Jilin, 130022, China.
Insights
Elevated serum lactate levels in pediatric sepsis patients are linked to increased mortality risk. A critical threshold of 2.2 mmol/L indicates a significantly higher chance of death within 28 days.
Area of Science:
- Pediatric critical care medicine
- Sepsis research
- Biomarker analysis
Background:
- Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.
- Lactate is a known biomarker for tissue hypoperfusion and severity in sepsis.
- Understanding the prognostic value of lactate in pediatric sepsis is crucial for timely intervention.
Purpose of the Study:
- To investigate the association between serum lactate levels on intensive care unit (ICU) admission and clinical outcomes in pediatric sepsis patients.
- To identify a potential threshold for lactate levels indicative of increased mortality risk.
Main Methods:
- Retrospective analysis of 288 pediatric sepsis patients from the Pediatric Intensive Care (PIC) database.
- Utilized segmented multivariable Cox regression and restricted cubic spline curves to analyze lactate levels and mortality.
- Conducted subgroup analyses to confirm findings.
Main Results:
- A 1 mmol/L increase in lactate was associated with a 17% rise in 28-day hospital mortality risk (HR: 1.17).
- Lactate levels ≥ 2.2 mmol/L significantly increased mortality risk (HR: 3.61).
- A non-linear correlation between lactate and 28-day mortality was observed, with an inflection point at 2.2 mmol/L.
Conclusions:
- Serum lactate levels exhibit a non-linear correlation with 28-day mortality in pediatric sepsis.
- A critical lactate threshold of 2.2 mmol/L is identified for increased mortality risk.
- Early lactate assessment in pediatric sepsis is recommended for prompt intervention and improved outcomes.
Objective:
This study aimed to investigate the relationship between serum lactate levels at admission to the intensive care unit (ICU) and the clinical outcomes of children with sepsis.
Methods:
We used the Pediatric Intensive Care (PIC) database to identify 288 pediatric patients with sepsis. We analyzed the relationship between lactate levels and hospital and ICU mortality in sepsis by establishing a segmented multivariable Cox regression model. We also conducted subgroup analysis as well as analyzed the restricted cubic spline curves.
Results:
After adjusting for all potential confounding factors, an increase of 1 mmol/L in lactate levels was found to be associated with an 17% rise in the 28-day hospital mortality risk among sepsis patients (HR: 1.17, 95% CI: 1.08-1.27, P = 0.0002). When considering lactate as a categorical variable, the mortality risk of patients with lactate levels ≥ 2.2 mmol/L was significantly increased (HR: 3.61, 95% CI: 1.24-10.54, P = 0.0189). The restricted cubic spline curve analysis revealed a nonlinear correlation between lactate and 28-day mortality, with an inflection point at 2.2 mmol/L. Similar findings were also observed in the assessment of secondary outcomes.
Conclusions:
Our study demonstrates a non-linear correlation between lactate levels and 28-day mortality in pediatric sepsis, with a critical threshold of 2.2mmol/l for lactate levels in septic patients. Early assessment of lactate levels is recommended for children with sepsis to facilitate prompt intervention and mitigate the risk of fatality.
