Lactate clearance as a predictor of mortality in neonatal sepsis
Abstract: Neonatal sepsis
remains the leading cause of neonatal deaths. Therefore, efforts should be made
to reduce its mortality. Lactate clearance can be used as a marker of onset of
hypoxia and microcirculation disorders, as well as to predict patient outcomes.
Objective To assess the use of lactate clearance to predict mortality
from neonatal sepsis.
Methods We conducted a prospective cohort study in the levels 2 and 3 of
neonatal care unit, Department of Child Health, Dr. Sardjito General Hospital,
Yogyakarta, from October to November 2011. We enrolled 40 neonatal sepsis
patients, who were divided into either the high or low lactate clearance
groups. All neonates were followed up until they were discharged from the
hospital, as to whether they survived or died. We performed blood lactate
measurements early on following their diagnosis of sepsis, and after the
subsequent six hours following the first antibiotic administration. Logistic
regression for the multivariate analysis and ROC curves for the accurate
analysis of predictive outcome factors were performed.
Results More deaths occurred in neonates with low lactate clearance at
six hours (48%) than in those in the high lactate clearance group (7%). Low
lactate clearance at six hours was a significant predictor of mortality (RR
15.1; 95%CI 1.7 to 133), whereas the ROC analysis showed moderate accuracy.
Conclusion Lactate clearance at six hours may be used as a predictor of
mortality in infants with neonatal sepsis.
Author: Felix Nathan Trisnadi,
Ekawaty Lutfia Haksari, Tunjung Wibowo
Journal Code: jpkedokterangg160111
