Serial blood lactate levels as a prognostic factor for sepsis mortality

Main Article Content

Keswari Aji Patriawati
Nurnaningsih Nurnaningsih
Purnomo Suryantoro

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.

Article Details

How to Cite
1.
Patriawati K, Nurnaningsih N, Suryantoro P. Serial blood lactate levels as a prognostic factor for sepsis mortality. PI [Internet]. 30Jun.2014 [cited 20Sep.2019];54(3):168-3. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/517
Section
Articles
Received 2016-09-09
Accepted 2016-09-09
Published 2014-06-30

References

1. Goldstein B, Giroir B, Randolph A, International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005;6:2-8.
2. Watson RS, Carcillo JA, Linde-Zwirble WT, Clermont G, Lidicker J, Angus DC. The epidemiology of severe sepsis in children in the United State. Am J Respir Crit Care Med. 2003;167:695-701.
3. Nurnaningsih, Setyowireni D, Rusmawatiningtyas D. Microbial pattern in pediatrics septicaemia at pediatric inten sive care unit Sardjito Hospital. Paed Indones. 2011;51(S):92.
4. Ikatan Dokter Anak Indonesia (IDAI). Diagnosis dan tata laksana sepsis pada anak. Rekomendasi Ikatan Dokter Anak Indonesia UKK Pediatri Gawat Darurat. Jakarta: BP IDAI; 2010. p. 1-21.
5. Duke T. Dysoxia and lactate. Arch Dis Child. 1999;81:343-50.
6. Bakker J, Coffernils M, Leon M, Gris P, Vincent JL. Blood lactate levels are superior to oxygen-derived variables in predicting outcome in human septic shock. Chest. 1991;99:956-62.
7. VincentJL. Lactate and biochemical indexes of oxygenation. In: Tobin MJ, editor. Principles and practice of intensive care 172 • Paediatr Irulones , Vol. 54, No. 3, May 2014 monitoring. New York: McGraw-Hill; 1998. p. 369-75.
8. Blomkalns AL Lactate a marker for sepsis and trauma. 2007 [cited 2012 May 21). Available from http://www.emcreg.org
9. Bakker J, Jansen TC. Don't take vitals, take a lactate. Intensive Care Med. 2007;33:1863-5.
10. Standage SW, Wong HR. Biomarkers for pediatric sepsis and septic shock. Expert Rev Anti Infect Ther. 2011;9:71-9.
11. Cicarelli DD, VieiraJE, Bensenor FE. Lactate as a predictor of mortality and multiple organ failure in patients with the systemic inflammatory response syndrome. Rev Bras Anestesiol. 2007;57:630-8.
12. Levraut J, Ciebiera JP, Chave S, Rabary 0, Jambou P, Carles M, et al. Mild hyperlactatemia in stable septic patients is due to impaired lactate clearance rather than overproduction. AmJ Respir Crit Care Med. 1998;157:1021-6.
13. Koliski A, Cat I, Giraldi DJ, Cat ML. Blood lactate concentration as prognostic marker in critically ill children. J Pediatr (Rio J). 2005;81:287-92.
14. Shapiro NI, Howell MD, Talmor D, Nathanson LA, Lisbon A, Wolfe RE, et al. Serum lactate as a predictor of mortality in emergency department patients with infection. Ann Emerg Med. 2005;45:524-8.
15. Hatherill M, McIntyre AG, Wattie M, Murdoch IA Early hyperlactataernia in critically ill children. Intensive Care Med. 2000;26:314-8.
16. Nguyen HB, Rivers EP, Knoblich BP, Jacobsen G, Muzzin A, Ressler JA, et al. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med. 2004;32:1637-42.
17. Nguyen HB, Loomba M, Yang JJ, Jacobsen G, Shah K, Otero RM, et al. Early lactate clearance is associated with biomarkers of inflammation, coagulation, apoptosis, organ dysfunction and mortality in severe sepsis and septic shock. J Inflamm. 2010;7:6.
18. Baldari C, Bonavolonta V, Emerenziani GP, Gallotta MC, Silva AJ, Guidetti L. Accuracy, reliability, linearity of Accutrend and Lactate Pro versus EBIO plus analyzer. Eur J Appl Physiol. 2009;107:105-11.
19. Carcillo JA, Fields A I. American College of Critical Care Medicine Task Force Committee Members. Clinical practice parameters for hemodynarnic support of pediatric and neonatal patients in septic shock. Crit Care Med. 2002;30:1365-78.
20. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med. 2003;29;530-8.
21. Bone RC, Sprung CL, Sibbald WJ. Definitions for sepsis and organ failure. Crit Care Med. 1992;20:724-6.
22. Reinhart K, Bloos F, Brunkhorst FM. Pathophisiology of sepsis and multiple organ dysfunction. In: Fink MP, Abraham E, Vincent JL, Kochanek PM, editors. Textbook of critical care. 5th ed. Philadelphia: Elsevier Saunders; 2005. p. 1249-58.
23. Parrillo JE, Parker MM, Natanson C, Suffredini AF, Danner RL, Cunnion RE, et al. Septic shock in humans. Advances in the understanding of pathogenesis, cardiovascular dysfunction, and therapy. Ann Intern Med. 1990;113:227-42.
24. Jansen TC, van BommelJ, Bakker J. Blood lactate monitoring in critically ill patients: a systemic health technology assessment. Crit Care Med. 2009;37:2827-39.
25. Nichol A, Bailey M, Egi M, Pettitla V, French C, Stachowski E, et al. Dynamic lactate indices as predictors of outcome in critically ill patients. Crit Care. 2011;15:R242.
26. Arnold RC, Shapiro NI, Jones AE, Schorr C, Pope J, Casner E, et al. Multicenter study of early lactate clearance as a determinant of survival in patients with presumed sepsis. Shock. 2009;32:35-9.
27. Jat KR, Jhamb U, Gupta VK. Serum lactate levels as the predictor of outcome in pediatric septic shock. Indian J Crit Care Med. 2011;15:102-7.
28. Han YY, Carcillo JA, Dragotta MA, Bills DM, Watson RS, Westerman ME, et al. Early reversal of pediatric-neonatal septic shock by community physicians is associated with improved outcome. Pediatrics. 2003;112:793-9.
29. Brierley J, Carcillo JA, Choong K, Cornell T, Decaen A, Deymann A, et al. Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Crit Care Med. 2009;37:666-88.
30. Puspanjono MT, Latief A, Tumbelaka AR, Sastroasmoro S, Gunardi H. Comparison of serial blood lactate level between dengue shock syndrome and dengue hemorrhagic fever (evaluation of prognostic value). Paediatr Indones. 2007;47:150-5.
31. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36:296-327.