Downloads
Abstract
Background: Sepsis is a leading cause of death in children around the world. Serum lactate is important in evaluating treatment effectiveness and predicting the severity of sepsis. In children, many studies have demonstrated the association between hyperlactatemia and low blood lactate clearance with multi - organ failure and in - hospital mortality in sepsis. However, until now it has not been possible to make a recommendation on the use of blood lactate in the risk classification of sepsis in children. The study aimed to describe clinical characteristics, serum lactate levels and results of treatment of pediatric sepsis.
Methods: The study was conducted using longitudinal research. A convenient sample of 106 children with sepsis was collected at the Pediatric Center - Hue Central Hospital from January 2021 to May 2023.
Results: High fever (72.6%) and tachypnea (80.2%) are the two most common clinical symptoms of sepsis. There are 45.3% of children with multi - organ dysfunction. The fatality rate was 35.8%. 75.5% of patients achieved lactate clearance. The lactate non - clearance group had a higher rate of decreased consciousness (50.0%), mechanical ventilation (38.5%), multi - organ dysfunction (76.9%), and death (84,6%) than the lactate clearance group (16.2%, 12.5%, 35.0%, and 20.0%) (p < 0.01). Serum lactate concentration at 24h was the best predictor of mortality in children with sepsis (cutoff point > 2.2 mmol/l had sensitivity of 78.9% and specificity of 88.2%, AUC = 0.897).
Conclusion: The lactate non-clearance group had a higher mortality rate than the lactate clearance group (p < 0,01). Serum lactate concentration at 24h was the best predictor of mortality in children with sepsis (cutoff point > 2.2 mmol/l).
References
Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, et al. Global, regional, and national causes of under-5 mortality in 2000- 15: an updated systematic analysis with implications for the Sustainable Development Goals. The Lancet. 2016;388(10063):3027-3035.
Weiss SL, Peters MJ, Alhazzani W, Agus MS, Flori HR, Inwald DP, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis- associated organ dysfunction in children. Intensive care medicine. 2020;46(1):10-67.
Tiến NM, Nhân NH, Hạnh NTG, Ngô Vũ Bích Ngọc, Hồng PT, Hiếu TT, et al. Điều trị sốc nhiễm khuẩn ở trẻ em tại khoa Cấp cứu Hồi sức Bệnh viện Nhi đồng thành phố. Tạp chí Truyền nhiễm Việt Nam. 2022;1(37):33-43.
Tuấn TA, Hà NTT. Đặc điểm rối loạn đông máu trên bệnh nhi sốc nhiễm khuẩn tại khoa Điều trị tích cực Bệnh viện Nhi Trung Ương. Tạp chí Y học Việt Nam. 2021;504(2):171 - 175.
Fine-Goulden MR, Durward A. How to use lactate. Archives of Disease in Childhood-Education and Practice. 2014;99(1):17-22.
Gómez H., Mizock B. A., Hyperlactatemia and lactic acidosis, in Critical care nephrology. 2019, Elsevier. p. 394-404. e3.
Alam A, Gupta S. Lactate measurements and their association with mortality in pediatric severe sepsis in India: evidence that 6-hour level performs best. Journal of intensive care medicine. 2020;36(4):443-450.
Choudhary R, Sitaraman S, Choudhary A. Lactate clearance as the predictor of outcome in pediatric septic shock. Journal of Emergencies, Trauma, and Shock. 2017;10(2):55.
Jaiswal P, Dewan P, Gomber S, Banerjee BD, Kotru M, Malhotra RK, et al. Early lactate measurements for predicting in - hospital mortality in paediatric sepsis. Journal of Paediatrics and Child Health. 2020;56(10):1570-1576.
Patil R. Plasma lactate levels and lactate clearance as predictors of outcome in patients with sepsis and septic shock. International Journal of Contemporary Pediatrics. 2020;7(6):1213 - 1217.
Scott HF, Brou L, Deakyne SJ, Fairclough DL, Kempe A, Bajaj L. Lactate Clearance and Normalization and Prolonged Organ Dysfunction in Pediatric Sepsis. The Journal of Pediatrics. 2016;170:1 - 7.e4.
Goldstein B., Giroir B., Randolph A. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005;6(1):2-8.
Phypers B, Pierce JT. Lactate physiology in health and disease. Continuing education in Anaesthesia. Critical care & Pain. 2006;6(3):128-132.
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. Critical care medicine. 2004;32(8):1637-1642.
Alqahtani MF, Marsillio LE, Rozenfeld RA. A review of biomarkers and physiomarkers in pediatric sepsis. Clinical Pediatric Emergency Medicine. 2014;15(2):177-184.
Nazir M, Wani W, Dar SA, Inamul-Haq M, Charoo BA, Ahmad QI, et al. Lactate clearance prognosticates outcome in pediatric septic shock during first 24 h of intensive care unit admission. Journal of the Intensive Care Society. 2019;20(4):290-298.
Nguyên PNT. Nghiên cứu lactate máu trong sốc nhiễm khuẩn trẻ em. Y học Thành phố Hồ Chí Minh. 2011;15(1):209 - 215.
Patriawati KA. Nurnaningsih N., Suryantoro P. Serial blood lactate levels as a prognostic factor for sepsis mortality. Paediatrica Indonesiana. 2014;54(3):168 - 173.
Dinakaran J, Yadav SS, Patel SK. Early lactate clearance in predicting in-hospital mortality in patients with sepsis admitted in the paediatric intensive care unit. Advances in Human Biology. 2023;13(2):187-191.
Celegen M, Celegen K. Is vasoactive-inotropic score associated with early lactate clearance a predictive outcome of children with septic shock? The Turkish Journal of Pediatrics. 2022;64(4):708-716.
Menon K, Schlapbach LJ, Akech S, Argent A, Biban P, Carrol ED, et al. Criteria for pediatric sepsis—a systematic review and meta-analysis by the pediatric sepsis definition taskforce. Critical care medicine. 2022;50(1):21.
Ngọc NTB, Nghiên cứu đặc điểm lâm sàng, cận lâm sàng, giá trị của lactat máu trong tiên lượng và đánh giá kết quả điều trị nhiễm trùng huyết trẻ em tại Bệnh viện Nhi đồng Cần Thơ. Luận án chuyên khoa cấp II, trường Đại học Y Dược Cần Thơ. 2016.
Filho RR, Rocha LL, Corrêa TD, Pessoa CMS, Colombo G, Assuncao MSC. Blood lactate levels cutoff and mortality prediction in sepsis—time for a reappraisal? A retrospective cohort study. Shock (Augusta, Ga.). 2016;46(5):480.
Japa A, Lunavath N, Raju V, Yerroju K. The role of serum lactate and lactate clearance as a surrogate marker for pediatric sepsis. Journal of Cardiovascular Disease Research. 2023;14(05):124 - 144.
Tonial CT, Costa CAD, Andrades GRH., Crestani F, Bruno F, Piva JP, et al. Performance of prognostic markers in pediatric sepsis. Jornal de Pediatria. 2021;97:287-294.
Kim YA, Ha EJ, Jhang WK, Park SJ. Early blood lactate area as a prognostic marker in pediatric septic shock. Intensive care medicine. 2013;39:1818-1823.
| Published | 12-06-2024 | |
| Fulltext |
|
|
| Language |
|
|
| Issue | No. 96 (2024) | |
| Section | Original article | |
| DOI | 10.38103/jcmhch.96.10 | |
| Keywords | Lactate huyết thanh, nhiễm khuẩn huyết, trẻ em Serum lactate, sepsis, children |
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright (c) 2024 Journal of Clinical Medicine Hue Central Hospital