Secondary Logo

Abstract O-57: LACTATE CLEARANCE AS A PROGNOSTIC MARKER OF MORTALITY IN SEVERELY ILL FEBRILE CHILDREN IN EAST AFRICA

Aramburo, A.1; Todd, J.2; George, E.C.3; Kiguli, S.4; Olupot-Olupot, P.5; Opoka, R.O.4; Engoru, C.6; Akech, S.O.7; Nyeko, R.8; Mtove, G.9; Gibb, D.M.10; Babiker, A.G.10; Matiland, K.7

Pediatric Critical Care Medicine: June 2018 - Volume 19 - Issue 6S - p 24
doi: 10.1097/01.pcc.0000537399.62731.c4
Oral Abstracts
Free

1Royal Brompton and Harefield, PICU, LONDON, United Kingdom

2LSHTM, Applied Biostatistics, London, United Kingdom

3Medical Reseach Council, Clinical Trials Unit, London, United Kingdom

4Mulago Hospital, Paediatrics, Kampala, Uganda

5Mbale Regional Referral Hospital, Paediatrics, Mbale, Uganda

6Soroti Regional Referral Hospital, Paediatrics, Soroti, Uganda

7KEMRI-Wellcome Trust Research Programme, Kilifi Clinical Trials Facility, Nairobi, Kenya

8St Mary’s Hospital, Paediatrics, Lacor, Uganda

9Teule Hospital, Paediatrics, Muheza, Tanzania

10Medical Research Council, Clinical Trials Unit, London, United Kingdom

Back to Top | Article Outline

Aims & Objectives:

Hyperlactataemia(HL) is a biomarker of disease severity that predicts mortality in patients with sepsis and malaria. Lactate clearance(LC) is a prognostic factor of survival in septic critically-ill adults. Little data exist in children living in malaria-endemic areas. Our main aim was to assess the prognostic value of LC at 8hrs on mortality at 72 hours(d72) in a large cohort of severely ill febrile children in an endemic-malaria area.

Back to Top | Article Outline

Methods

In a secondary data analysis of a fluid resuscitation trial(FEAST), we assessed the association between lactate levels at admission and LC at 8hrs with d72. LC was defined as a relative lactate decline ≥40% and/or lactate normalisation(<2.5 mmol/L).

Back to Top | Article Outline

Results

3008/3170 (95%) children had a baseline lactate measurement, 2127 (71%) had HL (lactate ≥2.5 mmol/L), and 1179 (39%) had severe HL (≥5 mmol/L). Within 72 hours 309 (10.3%) children died; 284 (92%) had baseline HL. After adjustment for potential confounders, severe HL was strongly associated with mortality (OR=6.96; 95%CI 3.52–13.76). This association was not modified by malaria status.

At 8 hours, 2748 (91%) survivors had a lactate measured; 1906 (63%) of whom had HL on admission.1014 (53%) fulfilled pre-defined LC criteria. After adjustment for confounders, LC at 8hrs strongly predicted survival (OR 0.24; 95%CI 0.14–0.42).

Back to Top | Article Outline

Conclusions

HL is a strong risk factor for d72 in children with severe febrile illnesses in Africa. LC within 8hrs predicts an improved chance of survival. These findings prompt the more widespread use of lactate and LC to identify children with severe disease and monitor response to treatment.

©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies