Lactate clearance as a predictor of mortality in neonatal sepsis

Main Article Content

Felix Nathan Trisnadi
Ekawaty Lutfia Haksari
Tunjung Wibowo

Abstract

Background Neonatal sepsis remains the leading cause of neonatal deaths. Therefore, efforts should be made to reduce its mortality. Lactate clearance can be used as a marker of onset of hypoxia and microcirculation disorders, as well as to predict patient outcomes.


Objective To assess the use of lactate clearance to predict mortality from neonatal sepsis.


Methods We conducted a prospective cohort study in the levels 2 and 3 of neonatal care unit, Department of Child Health, Dr. Sardjito General Hospital, Yogyakarta, from October to November 2011. We enrolled 40 neonatal sepsis patients, who were divided into either the high or low lactate clearance groups. All neonates were followed up until they were discharged from the hospital, as to whether they survived or died. We performed blood lactate measurements early on following their diagnosis of sepsis, and after the subsequent six hours following the first antibiotic administration. Logistic regression for the multivariate analysis and ROC curves for the accurate analysis of predictive outcome factors were performed.


Results More deaths occurred in neonates with low lactate clearance at six hours (48%) than in those in the high lactate clearance group (7%). Low lactate clearance at six hours was a significant predictor of mortality (RR 15.1; 95%CI 1.7 to 133), whereas the ROC analysis showed moderate accuracy.


Conclusion Lactate clearance at six hours may be used as a predictor of mortality in infants with neonatal sepsis.

Article Details

How to Cite
1.
Trisnadi F, Haksari E, Wibowo T. Lactate clearance as a predictor of mortality in neonatal sepsis. PI [Internet]. 31Aug.2016 [cited 17Sep.2019];56(4):193-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/765
Section
Articles
Author Biography

Tunjung Wibowo, Department of Child Health, Gadjah Mada University Medical School/Dr. Sardjito General Hospital, Yogyakarta, Central Java


Received 2016-10-03
Accepted 2016-10-03
Published 2016-08-31

References

1 WHO. Perinatal mortality. Report No: HO/FRH/MSM/967. Geneva:WHO; 1996. : 9
2 Evans TW, Smithies M. ABC of intensive care: organ dysfunction. BM J. 1999;318:1606-9.
3 Short MA. Linking the sepsis triad of inflammation, coagulation, and suppressed fibrinolysis to infants. Adv Neonatal Care. 2004;4:258-73.
4 Koliski A, Cat I, Giraldi DJ, Cat ML. Blood actate concentration as prognostic marker in critically ill children. J Pediatr (Rio K). 2005;81;287-92.
5 Kruse JA. Blood lactate concentration in sepsis. In: Vincent JL, Carlet J, Opal SM, editors. The sepsis text. 2nd ed. Massachussets: Kluwer Academics Publisher; 2002. p. 323-8.
6 Haque KN. Definitions of bloodstream infection in the newborn. Pediatr Crit Care Med. 2005;6:S45-9.
7 Weil MH, Afifi AA. Experimental and clinical studies on lactate and pyruvate as indicators of the severity of acute circulatory failure (shock). Circulation. 1970;41:989-1001.
8 Rashkin MC, Bosken C, Baughman RP. Oxygen delivery in critically ill patients. Relationship to blood lactate and survival. Chest. 1985;87:580-4.
9 Vincent JL, Dufaye P, Berré J, Leeman M, Degaute JP, Kahn RJ. Serial lactate determinations during circulatory shock. Crit Care Med. 1983;11:449-51.
10 Bakker J, Gris P, Coffernils M, Kahn RJ, Vincent JL. Serial blood lactate levels can predict the development of multiple organ failure following septic shock. Am J Surg. 1996;171:221-6.
11 Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368-77.
12 Nguyen HB, Rivers EP, Knoblic 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.
13 Jones AE, Puskarich MA. Sepsis-induced tissue hypoperfusion. Crit Care Clin. 2009;25:769-79.
14 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 patients with presumed sepsis. Shock. 2009;32:35-9.
15 Li-Xing Q, Zuan-Hao Q, Yi-Nan Z, Hai-Lang L, Xi-Rong G. Primary study on prognostic value of early arterial blood lactate clearance rate in the neonatal critical illness. Chinese Journal of Evidence -Based Pediatric.2010,5(6): 442-6.
16 Li-Juan Q, Li Y, Li-Xing Q, Yi-Nan Z. Clinical value of early lactate clearance rate on evaluation of prognosis in severe asphyxia neonate. J Appl Clin Pediatr. 2011,26:427-9.
17 Surjono A. Pencegahan dan pengobatan terhadap infeksi pada anak dan neonates dalam Kumpulan Makalah Reuni Dokter Spesialis Anak ke II FK UGM/RSUP Dr. Sardjito Yogyakarta. 1992.
18 Nguyen HB, Loomba M, Yang JJ, Jacobsen G, Shah K, Otero RM , et al. Early lactate clearance is associated with biomarkers of inflamation, coagulation, apoptosis, organ dysfunction and mortality in severe sepsis and septic shock. J Inflamm. 2010;7:6.
19 De Backer D, Verdat C, Chierego M, Koch M, Gullo A, et al. Effects of drotrecogin alfa activated on microcirculatory alterations in patients with severe sepsis. Crit Care Med. 2006;34:1918-24.
20 Ince C. The microcirculation is the motor of sepsis. Crit Care. 2005;9:S13-9.
21 Krishna U, Joshi SP, Modh M. An evaluation of serial blood lactate measurement as an early predictor of shock and its outcome in patients of trauma or sepsis. Indian J Crit Care Med. 2009;13:66–73.