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Published on: May 28, 2019
Serum lactate as a predictor of mortality after paediatric cardiac surgery
M Hatherill1, T Sajjanhar, S M Tibby
1Paediatric Intensive Care Unit, Guy's Hospital, London.
Insights
Sequential lactate measurements in children undergoing complex congenital heart surgery show poor positive predictive value for mortality. Routine lactate monitoring is not clinically justified for predicting outcomes in this patient group.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Biomarker Research
Background:
- Postoperative mortality in children with complex congenital heart disease remains a significant concern.
- Accurate prediction of mortality is crucial for timely intervention and resource allocation.
- Lactate levels are commonly used as a marker of tissue hypoperfusion and metabolic distress.
Purpose of the Study:
- To evaluate the effectiveness of sequential serum lactate measurements in predicting postoperative mortality.
- To determine the predictive value of initial and serial lactate levels in pediatric intensive care unit (PICU) patients.
- To assess if routine lactate monitoring is justified for mortality prediction after complex congenital heart surgery.
Main Methods:
- Prospective observational study conducted in a 16-bed PICU.
- Included 99 children undergoing surgery for complex congenital heart disease (90 survivors, 9 non-survivors).
- Serum lactate and base deficit measured on admission and every six hours; analyzed using Mann-Whitney and Fisher's exact tests.
Main Results:
- Initial lactate levels showed overlap between survivor and non-survivor groups, but were significantly higher in non-survivors (median 8.7 vs. 2.4 mmol/l, p=0.0002).
- An initial lactate threshold of 6 mmol/l offered optimal predictive value (sensitivity 78%, specificity 83%), but a low positive predictive value (32%).
- Twenty-one percent of patients with initial lactate > 4.5 mmol/l survived to PICU discharge, indicating limited predictive accuracy.
Conclusions:
- Initial serum lactate concentrations demonstrate poor positive predictive value for mortality in this cohort.
- Routine measurement of lactate is not clinically justified for predicting postoperative mortality after complex congenital heart surgery in children.
- Further research may be needed to identify more reliable biomarkers for this high-risk population.
Objective:
To assess the value of sequential lactate measurement in predicting postoperative mortality after surgery for complex congenital heart disease in children.
Design:
Prospective observational study.
Setting:
Sixteen bedded paediatric intensive care unit (PICU).
Subjects:
Ninety nine children (90 survivors, nine non-survivors).
Measurements:
Serum lactate and base deficit were measured on admission and every six hours thereafter. Data were analysed by Mann-Whitney and Fisher's exact tests.
Results:
There was considerable overlap in initial lactate values between the survivor and non-survivor groups. Initial lactate was significantly raised in non-survivors (median 8.7, range 1.9-17.6 mmol/l) compared with survivors (median 2.4, range 0.6-13.6 mmol/l) (p = 0.0002). Twenty one patients (21.1%) with initial lactate concentrations greater than 4.5 mmol/l survived to PICU discharge. Using receiver operating characteristic analysis an initial lactate of 6 mmol/l had the optimum predictive value for mortality. Initial postoperative serum lactate > 6 mmol/l predicted mortality with sensitivity 78%, specificity 83%, and positive predictive value of only 32%.
Conclusion:
Initial lactate concentrations have poor positive predictive value for mortality. The routine measurement of lactate for this purpose cannot be justified in clinical practice.
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