Lactate clearance and mortality in pediatric sepsis

Main Article Content

Dedi K. Saputra
Ari L. Runtunuwu
Suryadi N. N. Tatura
Jeanette I. Ch. Manoppo
Julius H. Lolombulan


Background Sepsis is a life-threatening condition often encountered in the pediatric intensive care unit. In the last five decades, despite the use of aggressive antibiotics and advances in intensive care medicine, the mortality rate of sepsis remains high. In 2005, the World Health Organization (WHO) estimated that 11 million children die annually due to sepsis, of these, 30,000 children under five years of age die daily. Serum lactate concentration is useful to evaluate the progression of sepsis in children. Lactate clearance can be used to evaluate the outcomes in sepsis management in children.

Objective To evaluate the relationship between lactate clearance and patient mortality. We also attempted to assess the usefulness of lactate clearance as an early prognostic marker in pediatric sepsis.

Methods This prospective cohort study was conducted at the Pediatrics Department of Prof Kandou General Hospital from November 2013 to April 2014. Consecutive sampling was undertaken on 45 children aged 1 month to 15 years who were diagnosed with sepsis according to the inclusion criteria. First lactate serum was measured immediately following patient admission to the PICU. The next serum lactate measurement was six hours after initial treatment in the PICU.

Results The mean lactate clearance was higher in the survivors’ than in the non-survivors’ group (58.48%vs. 18.20%, respectively). Logistic regression analysis revealed a lactate clearance cutoff point of 34.7%, with sensitivity 87.50%, specificity 96.55%, positive predictive value 93.33%, and negative predictive value 93.33%. The formula used was y=1/{1+exp-(4.135-0.119 lactate clearance)}. Chi-square analysis of lactate clearance and mortality revealed an odds ratio (OR) of 196.0 (95%CI 16.34 to 2,351.53; P<0.001).

Conclusion Higher lactate clearances significantly associate with lower mortality in children with sepsis.

Article Details

How to Cite
Saputra D, Runtunuwu A, Tatura S, Manoppo J, Lolombulan J. Lactate clearance and mortality in pediatric sepsis. PI [Internet]. 31Aug.2016 [cited 21Jul.2019];56(4):215-0. Available from:
Received 2016-10-03
Accepted 2016-10-03
Published 2016-08-31


1. World Health Organization: The Millenium Development Goals Report 2005. [cited 2013 September 28]. Available from:
2. Reed L, Carroll J, Cummings A, Markwell S, Wall J, Duong M. Serum lactate as a screening tool and predictor of outcome in pediatric patients presenting to the emergency department with suspected infection. Pediatr Emer Care. 2013;29:787-91.
3. Saez Lorens X, McCracken G H. Sepsis and septic shock in pediatrics: current concepts of terminology, phatophysiology and management. J Pediatr. 1995; 123:497-508.
4. Latief A. Pendekatan diagnosis sepsis. In: Lubis M, Evalina R, Irsa L, editors. Makalah lengkap simposium nasional pediatri gawat darurat VI. Medan: Bagian Ilmu Kesehatan Anak FK USU, 2003; p. 28-35.
5. Chairulfatah A. Sepsis dan syok septic. In: Sumarmo S, Soedarmo P, Hadinegoro SR, editors. Buku ajar ilmu kesehatan anak. Jakarta: Balai Penerbit FKU UI, 2002; p. 391-8.
6. Goldstein B, Giroir B, Randolph A; International Consensus Conference on Pediatric Sepsis. International pediatrics sepsis concensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005;6:2-8.
7. 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.
8. Jansen TC, van Bommel J, Woodward R, Mulder PG, Bakker J. Association between blood lactate levels, Sequential Organ Failure Assessment subscores, and 28-day mortality during early and late intensive care unit stay: a retrospective observational study. Crit Care Med. 2009;37:2369–74.
9. Kim YA, Ha EJ, Jhang WK, Park SJ. Early blood lactate area as a prognostic marker in pediatric septic shock. Intensive Care Med. 2013; 39:1818-23. doi: 10.1007/s00134-013-2959-z. Epub 2013 Jul 2.
10. Dharma AB, Rosalina I, Sekarwana N. Hubungan kadar laktat plasma dengan derajat disfungsi organ berdasarkan skor pelod pada anak dengan sakit kritis. Sari Pediatri. 2008;10:280-4.
11. Dewi R. Sepsis pada anak: pola kuman dan uji kepekaan. Maj Kedokt Ind. 2011;61:101-6.
12. Phypers B, Pierce JMT. Lactate physiology in health and disease. Crit Care & Pain. 2006;6:128-32.
13. Walker CA, Griffith DM, Gray AJ, Datta D, Hay AW. Early lactate clearance in septic patients with elevated lactate levels admitted from the emergency department to intensive care unit: time to aim higher? J Crit Care. 2013;28:832-7.
14. Jansen TC, van Bommel J, Schoonderbeek FJ, Sleeswijk Visser SJ, van der Klooster JM, Lima AP, et al. Early lactate-guided therapy in intensive care unit patients: a multicenter, open-label, randomized controlled trial. Am J Respir Crit Care Med. 2010;182:752-61.
15. Tian HH, Han SS, Lv CJ, Wang T, Li Z, Hao D, et al. The effect of early goal lactate clearance rate on the outcome of septic shock patients with severe pneumonia. Chin J Crit Care Med. 2012;24:42-5.
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. Puskarich MA, Trzeciak S, Shapiro NI, Albers AB, Heffner AC, Kline JA, et al. Whole blood lactate kinetics in patients undergoing quantitative resuscitation for severe sepsis and septic shock. Chest. 2013;143:1548-53.
18. Marty P, Roquilly A, Valee F, Luzi A, Ferre F, Fourcade O, et al. Lactate clearance for death prediction in severe sepsis or septic shock patients during the first 24 hours in Intensive Care Unit: an observational study. Ann Intensive Care. 2013;3:1-7.
19. Nguyen HB, Corbett SW, Steele R, Banta J, Clark RT, Hayes SR, et al. Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality. Crit Care Med. 2007;35:1105-13.
20. 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.