Lactate clearance and mortality in pediatric sepsis
Abstract: Sepsis is a
life-threatening condition often encountered in the pediatric intensive care
unit. In the last five decades, despite the use of aggressive antibiotics and
advances in intensive care medicine, the mortality rate of sepsis remains high.
In 2005, the World Health Organization (WHO) estimated that 11 million children
die annually due to sepsis, of these, 30,000 children under five years of age
die daily. Serum lactate concentration is useful to evaluate the progression of
sepsis in children. Lactate clearance can be used to evaluate the outcomes in
sepsis management in children.
Objective To evaluate the relationship between lactate clearance and
patient mortality. We also attempted to assess the usefulness of lactate
clearance as an early prognostic marker in pediatric sepsis.
Methods This prospective cohort study was conducted at the Pediatrics
Department of Prof Kandou General Hospital from November 2013 to April 2014.
Consecutive sampling was undertaken on 45 children aged 1 month to 15 years who
were diagnosed with sepsis according to the inclusion criteria. First lactate
serum was measured immediately following patient admission to the PICU. The
next serum lactate measurement was six hours after initial treatment in the
PICU.
Results The mean lactate clearance was higher in the survivors’ than in
the non-survivors’ group (58.48%vs. 18.20%, respectively). Logistic regression
analysis revealed a lactate clearance cutoff point of 34.7%, with sensitivity
87.50%, specificity 96.55%, positive predictive value 93.33%, and negative
predictive value 93.33%. The formula used was y=1/{1+exp-(4.135-0.119 lactate
clearance)}. Chi-square analysis of lactate clearance and mortality revealed an
odds ratio (OR) of 196.0 (95%CI 16.34 to 2,351.53; P<0.001).
Conclusion Higher lactate clearances significantly associate with lower
mortality in children with sepsis.
Author: Dedi K. Saputra, Ari
L. Runtunuwu, Suryadi N. N. Tatura, Jeanette I. Ch. Manoppo, Julius H.
Lolombulan
Journal Code: jpkedokterangg160120
