Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 20 , ISSUE 10 ( 2016 ) > List of Articles

RESEARCH ARTICLE

Validation of lactate clearance at 6 h for mortality prediction in critically ill children

Nirmal Kumar

Keywords : Lactate clearance, mortality prediction, pediatric index of mortality 2 score, Pediatric Intensive Care Unit

Citation Information : Kumar N. Validation of lactate clearance at 6 h for mortality prediction in critically ill children. Indian J Crit Care Med 2016; 20 (10):570-574.

DOI: 10.4103/0972-5229.192040

License: CC BY-ND 3.0

Published Online: 01-09-2017

Copyright Statement:  Copyright © 2016; The Author(s).


Abstract

Background and Aims: To validate the lactate clearance (LC) at 6 h for mortality prediction in Pediatric Intensive Care Unit (PICU)-admitted patients and its comparison with a pediatric index of mortality 2 (PIM 2) score. Design: A prospective, observational study in a tertiary care center. Materials and Methods: Children <13 years of age, admitted to PICU were included in the study. Lactate levels were measured at 0 and 6 h of admission for clearance. LC and delayed or nonclearance group compared for in-hospital mortality and compared with PIM 2 score for mortality prediction. Results: Of the 140 children (mean age 33.42 months) who were admitted to PICU, 23 (16.42%) patients died. For LC cut-off (16.435%) at 6 h, 92 patients qualified for clearance and 48 for delayed or non-LC group. High mortality was observed (39.6%) in delayed or non-LC group as compared to clearance group (4.3%) (P = 0.000). LC cut-off of 16.435% at 6 h (sensitivity 82.6%, specificity 75.2%, positive predictive value 39.6%, and negative predictive value 95.7%) correlates with mortality. Area under receiver operating characteristic (ROC) for LC at 6 h for mortality prediction was 0.823 (P = 0.000). The area under ROC curve for expected mortality prediction by PIM 2 score at admission was 0.906 and at 12.3% cut-off of PIM 2 Score was related with mortality. The mean PIM 2 score was high in delayed or non-LC group (25.25%) compared to LC group (10.95%) (P = 0.004). Conclusion: LC cut-off <16.435% at 6 h was associated with high mortality.


PDF Share
  1. Weil MH, Afifi AA. Experimental and clinical studies on lactate and pyruvate as indicators of the severity of acute circulatory failure (shock). Circulation 1970;41:989-1001.
  2. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992;101:1644-55.
  3. Trzeciak S, Dellinger RP, Chansky ME, Arnold RC, Schorr C, Milcarek B, et al. Serum lactate as a predictor of mortality in patients with infection. Intensive Care Med 2007;33:970-7.
  4. Green JP, Berger T, Garg N, Shapiro NI. Serum lactate is a better predictor of short-term mortality when stratified by C-reactive protein in adult emergency department patients hospitalized for a suspected infection. Ann Emerg Med 2011;57:291-5.
  5. Mikkelsen ME, Miltiades AN, Gaieski DF, Goyal M, Fuchs BD, Shah CV, et al. Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock. Crit Care Med 2009;37:1670-7.
  6. del Portal DA, Shofer F, Mikkelsen ME, Dorsey PJ Jr., Gaieski DF, Goyal M, et al. Emergency department lactate is associated with mortality in older adults admitted with and without infections. Acad Emerg Med 2010;17:260-8.
  7. Cerovic O, Golubovic V, Spec-Marn A, Kremzar B, Vidmar G. Relationship between injury severity and lactate levels in severely injured patients. Intensive Care Med 2003;29:1300-5.
  8. Hatherill M, McIntyre AG, Wattie M, Murdoch IA. Early hyperlactataemia in critically ill children. Intensive Care Med 2000;26:314-8.
  9. Nichol AD, Egi M, Pettila V, Bellomo R, French C, Hart G, et al. Relative hyperlactatemia and hospital mortality in critically ill patients: A retrospective multi-centre study. Crit Care 2010;14:R25.
  10. Suistomaa M, Ruokonen E, Kari A, Takala J. Time-pattern of lactate and lactate to pyruvate ratio in the first 24 hours of intensive care emergency admissions. Shock 2000;14:8-12.
  11. Smith I, Kumar P, Molloy S, Rhodes A, Newman PJ, Grounds RM, et al. Base excess and lactate as prognostic indicators for patients admitted to intensive care. Intensive Care Med 2001;27:74-83.
  12. Khosravani H, Shahpori R, Stelfox HT, Kirkpatrick AW, Laupland KB. Occurrence and adverse effect on outcome of hyperlactatemia in the critically ill. Crit Care 2009;13:R90.
  13. Nguyen HB, Rivers EP, Knoblich BP, Jacobsen G, Muzzin A, Ressler JA, et al. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med 2004;32:1637-42.
  14. Jansen TC, van Bommel J, Schoonderbeek FJ, Sleeswijk Visser SJ, van der Klooster JM, Lima AP, et al. Early lactate-guided therapy in Intensive Care Unit patients: a multicenter, open-label, randomized controlled trial. Am J Respir Crit Care Med 2010;182:752-61.
  15. Kliegel A, Losert H, Sterz F, Holzer M, Zeiner A, Havel C, et al. Serial lactate determinations for prediction of outcome after cardiac arrest. Medicine (Baltimore) 2004;83:274-9.
  16. Bakker J, Gris P, Coffernils M, Kahn RJ, Vincent JL. Serial blood lactate levels can predict the development of multiple organ failure following septic shock. Am J Surg 1996;171:221-6.
  17. Arnold RC, Shapiro NI, Jones AE, Schorr C, Pope J, Casner E, et al. Multicenter study of early lactate clearance as a determinant of survival in patients with presumed sepsis. Shock 2009;32:35-9.
  18. Munde A, Kumar N, Beri RS, Puliyel JM. Lactate clearance as a marker of mortality in pediatric Intensive Care Unit. Indian Pediatr 2014;51:565-7.
  19. Jansen TC, van Bommel J, Mulder PG, Lima AP, van der Hoven B, Rommes JH, et al. Prognostic value of blood lactate levels: does the clinical diagnosis at admission matter? J Trauma 2009;66:377-85.
  20. Cardinal Fernández PA, Olano E, Acosta C, Bertullo H, Albornoz H, Bagnulo H. Prognostic value of lactate clearance in the first 6 hours of intensive medicine course. Med Intensiva 2009;33:166-70.
  21. Puskarich MA, Trzeciak S, Shapiro NI, Albers AB, Heffner AC, Kline JA, et al. Whole blood lactate kinetics in patients undergoing quantitative resuscitation for severe sepsis and septic shock. Chest 2013;143:1548-53.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.