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Evaluation of the Association of Early Elevated Lactate With Outcomes in Children With Severe Sepsis or Septic Shock

Gorgis, Noelle MD*; Asselin, Jeannette M. PhD; Fontana, Cynthia BS; Heidersbach, R. Scott MD; Flori, Heidi R. MD§; Ward, Shan L. MD‡,∥

doi: 10.1097/PEC.0000000000001021
Original Articles
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Objective The aim of the study was to assess the association of initial lactate (L0) with mortality in children with severe sepsis.

Methods This prospective cohort study included 74 patients younger than 18 years with severe sepsis admitted to the pediatric intensive care unit (PICU) of a tertiary, academic children's hospital with lactate measured within 3 hours of meeting severe sepsis or septic shock. The primary outcome was in-hospital mortality. The secondary outcomes included PICU and hospital length of stay.

Results Although overall mortality was 10.5% (n = 18), patients with L0 measured (n = 72) had a higher mortality (16% vs 6%, P = 0.03) and higher median PRISM-III risk of mortality scores (P = 0.02) than those who did not. Median L0 was no different between nonsurvivors and survivors (3.6 mmol/L [interquartile range, 2.0–9.0] in nonsurvivors vs 2.3 mmol/L [interquartile range, 1.4–3.5] in survivors, P = 0.11). However, L0 was independently associated with PRISM-III score (coefficient, 1.12; 95% confidence interval, 0.4–1.8; P = 0.003) with an increase in mean PRISM-III score of 1.12 U for every 1 mmol/L increase in L0, with L0 accounting for 12% of the variability in PRISM-III scores between patients. There was no association between L0 and PICU or hospital length of stay.

Conclusions Although our single center study did not demonstrate that an elevated early lactate is associated with mortality in pediatric severe sepsis, L0 did correlate strongly with PRISM-III, the most robust measure of mortality risk in pediatrics. Therefore, early lactate measurement may be important as an early biomarker of disease severity. These data should be validated in a larger, multicenter, prospective study.

From the *Department of Pediatrics

Neonatal-Pediatric Research Group

Division of Pediatric Critical Care, UCSF Benioff Children's Hospital Oakland, Oakland, CA

§Division of Pediatric Critical Care Medicine, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, MI

Division of Pediatric Critical Care, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA.

Disclosure: The authors declare no conflict of interest.

Reprints: Shan Ward, MD, 550 16th St, 5th Floor, Box 0106, San Francisco, CA 94143 (e-mail: shan.ward@ucsf.edu).

Supported by National Institutes of Health grants 5T32HD049303-08 (S.L.W.), Charlotte Coleman Frey Fellowship Fund (S.L.W.), and Department of Defense TATRC W81XWH (J.M.A., C.F., R.S.H., H.R.F.).

Online date: January 9, 2017

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