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- Title
THE ROLE OF SERUM LACTATE AND LACTATE CLEARANCE AS A SURROGATE MARKER FOR PEDIATRIC SEPSIS.
- Authors
Japa, Avinash; Lunavath, Narayana; Raju, Vannala; Yerroju, Kodandapani
- Abstract
Introduction: Sepsis is an important cause of mortality and morbidity in children. Paediatric sepsis in India has a high mortality rate of 40%, which necessitates early risk stratification and timely escalation of level of care for improving survival. Biochemical markers such as serum lactate are helpful in such cases. Lactate is frequently measured to estimate the extent of hypoxia at cellular level, and it correlates well with indices of end organ perfusion. Serum lactate level can be measured at bed side with rapid turn around time. Lactate testing is simple, inexpensive and reasonably sensitive tool for prognostication. Very few studies regarding lactate and lactate clearance have been done in paediatric population. Materials and Methods: 46 children aged between 1 month and 14 years of age were studied. Arterial blood sample was collected, and lactate levels were measured bedside using Abbott i-STAT. 300 handheld blood analyser at admission, 6 hours, 12 hours, 18 hours, 24 hours, 36 hours and 48 hours. Lactate clearance was calculated. PRISM III score (Pediatric severity index) was done on all patients on admission. Chi-square test was applied to check the dependency of different parameters on outcome (survival or non-survival) of the patients. Unpaired t-test is used to compare the means of different parameters since the standard deviation of the population is unknown. Spearman's correlation coefficient between blood lactate on admission and PRISM III score was obtained. Sensitivity, specificity for diagnostic tests were obtained. Receiver's operative curve was also obtained to get the area under the curve and cut off point for prediction. Results: Out of 46 cases, 45.7% were males and 54.3% were females. Majority (45.7%) cases were in the age groups of 1 to 5 years and 21.7% belonged to age <1 year. Mean age was 5.3 years in nonsurvivors and 4.9 years in survivors group. Lower respiratory tract infection was the major cause of PICU admission (43.47%). Majority (78.3%) had PRISM III score of 1 to 5. Majority of study participants had PRISM III score ranging between 1-5, followed by 11-15. Among 46 cases 91.3% had hyperlactatemia (>2mmol/L) on admission. Among 46 cases, 19.6% were non-survivors. Inotropes usage was 18.9% in survivors and 66.7% in non-survivors. This difference was found to be statistically significant (P value <0.05). Conclusion: Mean lactate levels were always higher in non-survivors as compared to survivors at all points of time from admission till 48 hours. Area under the curve for lactate levels was significant at all time points for predicting mortality. The best cut off values of lactate for predicting mortality with maximum sensitivity and specificity were 4.94 mmol/l at admission, 4.15 mmol/l at 6 hours, 4 mmol/l at 12 hours, 3.75 mmol/l at 18 hours, 3.22 mmol/l at 24 hours, 2.85 mmol/l at 36 hours and 2.55 mmol/l at 48 hours. Mean PRISM III score was more in non-survivors (15.00) as compared to survivors (2.51) and this difference was found to be statistically significant.
- Subjects
INDIA; HYPERLACTATEMIA; BIOMARKERS; BLOOD lactate; LACTATES; CHILD patients; SEPSIS; RESPIRATORY infections
- Publication
Journal of Cardiovascular Disease Research (Journal of Cardiovascular Disease Research), 2023, Vol 14, Issue 5, p124
- ISSN
0975-3583
- Publication type
Article