Comparison of serial blood lactate level between dengue shock syndrome and dengue hemorrhagic fever (evaluation of prognostic value)
Keywords:
serial blood lactate, dengue shock syndrome, prognostic
Abstract
Background Dengue shock syndrome (DSS) mortality is still high.Monitoring of blood lactate level is important to evaluate shock.
Objectives The study were to review the difference between blood
lactate level of DSS and that of dengue hemorrhagic fever (DHF),
to correlate blood lactate level with hypoxia state as shock risk
factors (PaO 2 , oxygen saturation, and anion gap) and to determine
the cut-off point of blood lactate level to predict shock.
Methods The study was carried out at the Department of Child
Health, Medical School, University of Indonesia, Cipto
Mangunkusumo Hospital, Jakarta, from January until July 2006.
Three mL venous blood specimen was collected from all subjects
for peripheral blood, blood gasses, serology, and blood lactate
examinations. This study consisted of a retrospective cohort and
a cross sectional method. Data were analyzed with Chi-square
test. Continous data tested using Mann-Whitney method. To
know the correlation between blood lactate level and shock risk
factors we use logistic regression test.
Results In DSS group, 73% shows hyperlactatemia (lactate =2
mmol/L). Conversion of lactate means between two groups is
significantly different from day one to day two and three. There
was a negative correlation between lactate level and pO 2 and
oxygen saturation. Oxygen saturation is the only value that has
clinical correlation. Regressions analysis can be applied using Y
= 7.05–0.05 X equation. The cut-off point of lactate level as
marker for shock by using ROC curve is 32.015 mmol/L with 70%
sensitivity and 83.3% specificity.
Conclusions Hyperlactatemia in DSS can be considered as a sign
for unappropriate treatment of shock. Blood lactate level can be
used as a biochemical marker for tissue hypoxia, to assess severity
of the disease, as monitoring of treatment, and has prognostic
value of DHF cases.
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demam berdarah dengue. [Thesis]. Jakarta: Departemen Ilmu
Kesehatan Anak FKUI; 2004.
27. Krishna S, Supanaranond W, Pukrittayakamee S, Karter D,
Supputamongkol Y, Davis TM, et al. Dichloroacetate for lactic
acidosis in severe malaria: a pharmacokinetic and pharma-
codynamic assessment. Metabolism 1994;43:974-81.
28. Bonet JI, Santamaria ML, Tarrio FR, Paz-Cruz JA, Roque J,
Gamez M, et al. Oxygen consumption, lactate metabolism,
and gastric intramucosal pH in an experimental liver trans-
plantation model. Crit Care Med 1998;26:1850-6.
demam berdarah dengue, perhatian khusus pada syok,
produksi TNF-α, Interleukin-6, dan sebagai faktor prediktor
demam berdarah dengue berat [dissertation]. Jakarta: Uni-
versitas Indonesia; 1996.
2. Dewi R. Gambaran klinis demam berdarah dengue dan faktor
risiko yang memprediksi terjadinya renjatan [thesis]. Jakarta:
Departemen Ilmu Kesehatan Anak FKUI; 2005.
3. Vincent JL. Lactate and biochemical indexes of oxygenation.
In: Tobin MJ, editor. Principles and practice of intensive care
monitoring. New York: McGraw-Hill Companies; 1998. p.
369-75.
4. Stacpoole PW. Lactic acidosis. Endocrinol Metabol Clin
North Am 1993;22:221-45.
5. Mustafa I. Pintas jantung paru pada bedah jantung
menyebabkan gangguan metabolisme laktat di hati. [Disser-
tation]. Jakarta: Universitas Indonesia; 2002.
6. Bakker J, Gris P, Coffernils M, Kahn RJ, Vincent JL. Serial
blood lactate levels can predict the the development of mul-
tiple organ failure following septic shock. Am J Surg
1996;171:221-6.
7. Bakker J, Coffernils M, Leon M, Gris P, Vincent JL. Blood lactate
levels are superior to oxygen-derived variables in predicting out-
come in human septic shock. Chest 1991;99:956-62.
8. Siswanto JE. Kadar asam laktat darah pada penderita sepsis
[thesis]. Semarang: Bagian Ilmu Kesehatan Anak FK
UNDIP; 1997.
9. Matthews JG, Lisbon A. Lactate metabolism in the critically
ill patient. In: Cerra FB, editor. Pharmacology, metabolism
and nutrition. Current Opinion in Crit Care 1995;1:267-71.
10. Arieff AL. Lactic acidosis: pathophysiology, classification and
therapy of acid-base disturbances. In: Arieff AI, DeFronzo
RA, editors. Fluid, electrolyte and acid-base disorders. 2 nd
ed. New York: Churchill Livingstone; 1995. p. 130-6.
11. Setiati TE, Soemantri Ag. Blood lactic acids as a predictor
of mortality in severe dengue haemorrhagic fever in dr.
Kariadi Hospital–Semarang, Central Java [dissertation].
Semarang: Universitas Diponegoro; 1997.
12. World Health Organization. Dengue hemorrhagic fever: di-
agnosis, treatment, prevention and control. Geneva: WHO;
1997. p. 1-83.
13. World Health Organization. Guidelines for treatment of den-
gue fever/dengue hemorrhagic fever in small hospitals. 1 st
ed. New Delhi: WHO Regional Office for South-East Asia;
1999. p. 16-8.
14. Sumarmo. Masalah demam berdarah dengue di Indonesia.
In: Harun SR, Satari HI, editors. Demam berdarah dengue.
Naskah lengkap pelatihan bagi pelatih Dokter Spesialis Anak
dan Dokter Spesialis Penyakit Dalam dalam tatalaksana kasus
demam berdarah dengue. 1 st ed. Jakarta: Balai Penerbit FKUI;
1999. p. 1-5.
15. Tumbelaka AR. Diagnosis demam dengue/demam berdarah
dengue. In Harun SR, Satari HI, editors. Demam berdarah
dengue. Naskah lengkap pelatihan bagi pelatih Dokter
Spesialis Anak dan Dokter Spesialis Penyakit Dalam
tatalaksana kasus demam berdarah dengue. 1 st ed. Jakarta:
Balai Penerbit FKUI; 1999. p. 73-9.
16. Mizock BA, Falk JL. Lactic acidosis in critical illness. Crit
Care Med 1992;20:80-93.
17. Levraut J, Ciebiera JP, Chave S, Rabary O, Jambou P, Carles
M, et al. Mild hyperlactatemia in stable septic patients is due
to impaired lactate clearence rather than overproduction.
Am J Respir Crit Care Med 1998;157:1021-6.
18. Latief A. Gangguan keseimbangan asam basa. In: Unit Kerja
Koordinasi Pediatri Gawat Darurat Ikatan Dokter Anak In-
donesia, editor. Kumpulan materi pelatihan resusitasi
pediatrik tahap lanjut. Presented at Advanced Paediatric
Resuscitation Care Angkatan VII; 2001 July 28-29; Jakarta,
Indonesia.
19. Douzinas EE, Tsidemiadou PD, Pitaridis MT, Andrianakis I,
Bobota-Chloraki A, Katsouyanni K, et al. The regional pro-
duction of cytokines and lactate in sepsis-related multiple
organ failure. Am J Respir Crit Care Med 1997;155:53-9.
20. Duke T. Dysoxia and lactate. Arch Dis Child 1999;81:343-
50.
21. Aduen J, Berstein WK, Khastgir T, Miller J, Kerzner R,
Bhatiani A, et al. The use and clinical importance of a sub-
strate-specific electrode for rapid determination of blood lac-
tate concentration. JAMA 1994;272:1678-84.
22. Backer DD, Creteur J, Zhang H, Norrenberg M, Vincent JL.
Lactate production by the lung in acute lung injury. Am J
Respir Crit Care Med 1997;156:1099-104.
23. Hendarto H. Gambaran kadar laktat darah pada penderita
ketoasidosis yang meninggal dalam 24 jam pertama di
Instalasi Gawat Darurat RSUPNCM antara bulan Maret-
Agustus 2002. Laporan penelitian. Jakarta: Universitas In-
donesia; 2003.
24. Wang F, Butler T, Rabbani GH, Jones PK. The acidosis of
cholera: contribution of hyperproteinemia, lactic acidemia,
and hyperphosphatemia to an increased blood anion gap. N
Engl J Med 1986;315:1591-5.
25. Madiyono B, Moeslichan S, Sastroasmoro S, Budiman I,
Purwanto SH. Perkiraan besar sampel. In: Sastroasmoro S,
Ismail S, editors. Dasar-dasar metodologi penelitian klinis.
2 nd ed. Jakarta: Sagung Seto; 2002. p. 259-86.
26. Karyanti MR. Perbandingan pemeriksaan cairan ringer asetat
dan ringer laktat terhadap perubahan aminotransferase pada
demam berdarah dengue. [Thesis]. Jakarta: Departemen Ilmu
Kesehatan Anak FKUI; 2004.
27. Krishna S, Supanaranond W, Pukrittayakamee S, Karter D,
Supputamongkol Y, Davis TM, et al. Dichloroacetate for lactic
acidosis in severe malaria: a pharmacokinetic and pharma-
codynamic assessment. Metabolism 1994;43:974-81.
28. Bonet JI, Santamaria ML, Tarrio FR, Paz-Cruz JA, Roque J,
Gamez M, et al. Oxygen consumption, lactate metabolism,
and gastric intramucosal pH in an experimental liver trans-
plantation model. Crit Care Med 1998;26:1850-6.
Published
2007-08-31
How to Cite
1.
Puspanjono M, Latief A, Tumbelaka A, Sastroasmoro S, Gunardi H. Comparison of serial blood lactate level between dengue shock syndrome and dengue hemorrhagic fever (evaluation of prognostic value). PI [Internet]. 31Aug.2007 [cited 25Apr.2024];47(4):150-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/367
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Received 2016-08-28
Accepted 2016-08-28
Published 2007-08-31
Accepted 2016-08-28
Published 2007-08-31
