Lactate clearance as the predictor of outcome in pediatric septic shock.
TLDR
A 24 h lactate clearance cut-off of <10% is a predictor of in-hospital mortality in children with septic shock, andSerial lactate levels can be used to predict outcome in Pediatrics.Abstract:
Context: Septic shock can rapidly evolve into multiple system organ failure and death. In the recent years, hyperlactatemia has been found to be a risk factor for mortality in critically ill adults. Aims: To evaluate the predictive value of lactate clearance and to determine the optimal cut-off value for predicting outcome in children with septic shock. Settings and Design: A prospective observational study was performed on children with septic shock admitted to pediatric Intensive Care Unit (PICU). Subjects and Methods: Serial lactate levels were measured at PICU admission, 24 and 48 h later. Lactate clearance, percent decrease in lactate level in 24 h, was calculated. The primary outcome measure was survival or nonsurvival at the end of hospital stay. We performed receiver operating characteristic analyses to calculate optimal cut-off values. Results: The mean lactate levels at admission were significantly higher in the nonsurvivors than survivors, 5.12 ± 3.51 versus 3.13 ± 1.71 mmol/L (P = 0.0001). The cut-off for lactate level at admission for the best prediction of mortality was determined as ≥4 mmol/L (odds ratio 5.4; 95% confidence interval [CI] =2.45–12.09). Mean lactate clearance was significantly higher in survivors than nonsurvivors (17.9 ± 39.9 vs. −23.2 ± 62.7; P < 0.0001). A lactate clearance rate of <10% at 24 h had a sensitivity and specificity of 78.7% and 72.2%, respectively and a positive predictive value of 83.1% for death. Failure to achieve a lactate clearance of more than 10% was associated with greater risk of mortality (likelihood ratio + 2.83; 95% CI = 1.82–4.41). Conclusions: Serial lactate levels can be used to predict outcome in pediatric septic shock. A 24 h lactate clearance cut-off of <10% is a predictor of in-hospital mortality in such patients.read more
Citations
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Early goal-directed therapy in the treatment of severe sepsis and septic shock
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Point-of-care testing (POCT) and evidence-based laboratory medicine (EBLM) – does it leverage any advantage in clinical decision making?
Christopher Florkowski,Andrew C. Don-Wauchope,Nuria Giménez,Karina Rodriguez-Capote,Julien Wils,Annalise E Zemlin +5 more
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Emergency Department Management of Pediatric Shock
TL;DR: Early recognition of shock can be made with close attention to historical clues, physical examination and vital sign abnormalities, and aggressive treatment can prevent or reverse organ dysfunction and improve morbidity and mortality.
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Association of lactate/albumin ratio level to organ failure and mortality in severe sepsis in a pediatric intensive care unit in Egypt.
TL;DR: It was concluded that lactate/albumin ratio is a better discriminator of MODS development and mortality than lactate clearance in pediatric patients with severe sepsis or septic shock.
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Early Lactate Dynamics in Critically Ill Non-Traumatic Patients in a Resuscitation Room of a German Emergency Department (OBSERvE-Lactate-Study).
Andre Kramer,Norman Urban,Stephanie Döll,Thomas Hartwig,Maryam Yahiaoui-Doktor,Ralph Burkhardt,Sirak Petros,André Gries,Michael Bernhard +8 more
TL;DR: In critically ill ED patients initially requiring treatment in a resuscitation room setting, LD at 6 h and LacTW may predict their survival beyond 30 days, and these findings need to be confirmed in a prospective study design.
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