Serial blood lactate levels as a prognostic factor for sepsis mortality
Abstract
Background Sepsis is a major health problem in children and a
leading cause of death. In recent decades, lactate has been studied
as a biomarker for sepsis, and as an indicator of global tissue
hypoxia, increased glycolysis, endotoxin effect, and anaerobic
metabolism. Many studies h ave shown both high levels and
increased serial blood lactate level measurements to be associated
with increased risk of sepsis mortality.
Objective To evaluate serial blood lactate levels as a prognostic
factor for sepsis mortality.
Methods We performed an observational, prospective study in the
Pediatric Intensive Care Unit (PICU) at DR. Sardjito Hospital,
Yogyakarta from July to November 2012. We collected serial
blood lactate specimens of children with sepsis, first at the time of
admission, followed by 6 and 24 hours later. The outcome measure
was mortality at the end ofintensive care. Relative risks and 95%
confidence intervals of the factors associated with mortality were
calculated using univariate and multivariate analyses.
Results Sepsis was found in 91 (50.3%) patients admitted to
the PIW , of whom 75 were included in this study. Five patients
(6. 7%) died before the 24-hour lactate collection and 39 patients
(52.0%) died during the study. Blood lactate levels of ~ 4mmol;L
at the first and 24-hour specimens were associated with mortality
(RR 2.9; 95%CI 1.09 to 7 .66 and RR 4.92; 95%CI 1.77 to 13.65,
respectively). Lactate clearance of less than 10% at 24 hours
(adjusted RR 5.3; 95% CI 1.1 to 24.5) had a significantly greater
risk fo llowed by septic shock (adjusted RR 1.54; 95%CI 1.36 to
6.4 7) due to mortality.
Conclusion In children with sepsis there is a greater risk of mortality
in those with increasing or persistently high serial blood lactate
levels, as shown by less than 10% lactate clearance at 24-hours after
PIW admission.
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Accepted 2016-09-09
Published 2014-06-30
