Study of Blood Lactate Levels at Admission as a Predictor of Mortality and Morbidity in Critically Ill Children in a Tertiary Care Pediatric Intensive Care Unit
Aleti Samatha
Yashoda Hospitals, Somajiguda, Hyderabad, India.
Suresh Kumar Panuganti *
Yashoda Hospitals, Somajiguda, Hyderabad, India.
Venkateshwar Vempati
NICE Hospital for Women, Newborns and Children, Hyderabad, India.
Sudha Boda
Yashoda Hospitals, Somajiguda, Hyderabad, India.
*Author to whom correspondence should be addressed.
Abstract
Background and Aim: Patients with severe illness are at an elevated risk of experiencing multiple organ failure, which in turn increases their likelihood of mortality. Hyperlactatemia is recognized as a distinct risk factor for the onset of organ dysfunction and mortality, as well as morbidity in children’s. Present study aims to to determine threshold values for the prediction of in-hospital mortality in the larger cohort of critically ill children and to evaluate the predictive value of blood lactate levels at admission.
Methods: This prospective observational study was conducted with 202 critically ill children, ranging in age from one month to 18 years, admitted to the Pediatric Intensive Care Unit (PICU). Arterial blood samples were obtained upon admission, and subsequent measurements of lactate levels were conducted. The demographical data, clinical status and organ involvement were recorded. Statistical analysis was performed by using SPSS Version 21.0 and P < 0.05 was considered to be significant.
Results: Survivors geometric mean lactate levels at admission were lower (1.2 mmol/L) than non-survivors' (4.8 mmol/L), and higher lactate levels at admission were substantially linked to both mortality and morbidity (length of hospital stay, need for ventilator and inotropic support). The sensitivity and specificity of the blood lactate levels were 93.6% and 89.7%, achieved at the optimal cut-off value of 4.05 mmol/L. The incidence of multi organ dysfunction, need for ventilator and inotropic support, duration of hospital stay in critically ill children was significantly associated with increased blood lactate levels at admission (P<0.01).
Conclusion: A high level of blood lactate upon admission was independently predictive of in-hospital mortality in the pediatric population. The early identification of children who are at a high risk for mortality allows for prompt intervention, thereby enhancing the overall outcomes.
Keywords: Blood lactate, critically ill children, cut-off value, hospital stay, hospital outcome