Lactate Clearance and Normalization and Prolonged Organ Dysfunction in Pediatric Sepsis

J Pediatr. 2016 Mar;170:149-55.e1-4. doi: 10.1016/j.jpeds.2015.11.071. Epub 2015 Dec 19.

Abstract

Objectives: To evaluate whether lactate clearance and normalization during emergency care of pediatric sepsis is associated with lower rates of persistent organ dysfunction.

Study design: This was a prospective cohort study of 77 children <18 years of age in the emergency department with infection and acute organ dysfunction per consensus definitions. In consented patients, lactate was measured 2 and/or 4 hours after an initial lactate; persistent organ dysfunction was assessed through laboratory and physician evaluation at 48 hours. A decrease of ≥ 10% from initial to final level was considered lactate clearance; a final level < 2 mmol/L was considered lactate normalization. Relative risk (RR) with 95% CIs, adjusted in a log-binomial model, was used to evaluate associations between lactate clearance/normalization and organ dysfunction.

Results: Lactate normalized in 62 (81%) patients and cleared in 70 (91%). The primary outcome, persistent 48-hour organ dysfunction, was present in 32 (42%). Lactate normalization was associated with decreased risk of persistent organ dysfunction (RR 0.46, 0.29-0.73; adjusted RR 0.47, 0.29-0.78); lactate clearance was not (RR 0.70, 0.35-1.41; adjusted RR 0.75, 0.38-1.50). The association between lactate normalization and decreased risk of persistent organ dysfunction was retained in the subgroups with initial lactate ≥ 2 mmol/L and hypotension.

Conclusions: In children with sepsis and organ dysfunction, lactate normalization within 4 hours was associated with decreased persistent organ dysfunction. Serial lactate level measurement may provide a useful prognostic tool during the first hours of resuscitation in pediatric sepsis.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Biomarkers / blood
  • Child
  • Cohort Studies
  • Emergency Service, Hospital
  • Humans
  • Hypotension / complications
  • Lactic Acid / blood*
  • Multiple Organ Failure / blood*
  • Multiple Organ Failure / etiology
  • Organ Dysfunction Scores
  • Prognosis
  • Sepsis / blood*
  • Sepsis / complications
  • Time Factors

Substances

  • Biomarkers
  • Lactic Acid