• Turk J Med Sci · Dec 2022

    Observational Study

    Could lactate clearance be a marker of mortality in pediatric intensive care unit?

    • Özlem Saraç Sandal, Gökhan Ceylan, Ferhat Sarı, Gülhan Atakul, Mustafa Çolak, Sevgi Topal, Ekin Soydan, Ünal Utku Karaarslan, and Hasan Ağın.
    • Department of Pediatric Intensive Care Unit, Dr. Behçet Uz Pediatrics Training and Research Hospital, İzmir, Turkey.
    • Turk J Med Sci. 2022 Dec 1; 52 (6): 177117781771-1778.

    BackgroundHyperlactatemia is a common finding in critically ill patients and has significant prognostic implications. However, a single lactate measurement has not been correlated to mortality consistently. In this study, we aimed to correlate the clinical efficacy of lactate clearance for the prediction of mortality in pediatric intensive care unit patients.MethodsThis retrospective observational study was performed in the pediatric intensive care unit in patients with lactate level >3 mmol/lt. Initial, 6th h, and 24th h lactate levels were recorded and lactate clearance was calculated using these values (lactate level at admission - level 6 h later × 100/lactate level at admission).ResultsA total of 172 patients were included in the study. Forty-four out of 172 patients died. Median (IQR) lactate (mmol/L) at admission was low in those who survived in comparison to nonsurvivors 4.4 (3.1) vs. 5.75 (7.7) (p = 0.002). Clearance at 6th h was significantly lower in those who died (11.7%) than those who survived (36.7) (p = 0.001). 6th h lactate clearance level <20.7% predicted mortality with a sensitivity of 63.6% and specificity of 69.5% along with a positive predictive value of 41.8 and a negative predictive value of 84.8 (p = 0.004). Both lactate levels and lactate clearance values were significantly predictive factors for mortality (p < 0.05). Only a positive moderate correlation was found between the percentage of PRISM-IV % and 6th h lactate level.DiscussionThe present study revealed that lactate clearance is a simple and rapid risk-stratification tool holding to be a potential biomarker of managing the treatment efficacy of children in the pediatric intensive care unit.

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