Lactate Clearance as an Early Prognostic Marker of Mortality for Pediatric Trauma

Abstract

Background While lactate clearance (LC) has already been shown as a prognostic indicator in clinical studies, its certain character needs to be defined in pediatric trauma. This research aimed to evaluate the correlation between early lactate clearance and mortality in pediatric trauma.Patients and methods A retrospective cohort study was conducted in a university hospital. Repeated LC was measured at admission, at the 2nd, 6th, and 12th hours post-admission. The association of lactate clearance with mortality was analyzed and using receiver operating characteristic (ROC) to determine the threshold levels of lactate clearance and also logistic regression analysis was performed to determine whether LC was an independent risk factor.Results Seventy-eight patients were included and overall mortality was 13%. LC values of the non-survivors was significantly lower than survivors for LC0–2 h (28.60±14.26 vs 4.64±15.90), LC0–6 h (46.63±15.23 vs 3.33±18.07), LC0–12 h (56.97±15.53 vs 4.82±22.59) (p:<0.001, p:<0.001 and p:<0.001, respectively). Areas under the curve of lactate clearance at the 2nd, 6th, and 12th hours after therapy start were a significant predictor for mortality (p:<0.001, p:<0.001, and p:<0.001, respectively). Threshold values of LC were 12.9, 19.5 and 29.3%, respectively.Conclusion Lactate clearance was a beneficial tool to estimate outcomes of pediatric trauma. Poor lactate clearance was a significant marker for poor prognosis.

Zusammenfassung

Hintergrund Während die Laktat-Clearance (LC) in klinischen Studien bereits als prognostischer Indikator nachgewiesen wurde, muss ihr bestimmter Charakter bei pädiatrischen Traumata noch definiert werden. Ziel dieser Untersuchung war es, den Zusammenhang zwischen der frühen Laktatabgabe und der Sterblichkeit bei pädiatrischen Traumata zu bewerten. Patienten undMethoden Es wurde eine retrospektive Kohortenstudie in einem Universitätskrankenhaus durchgeführt. Die wiederholte LC wurde bei der Aufnahme sowie 2, 6 und 12 Stunden nach der Aufnahme gemessen. Der Zusammenhang zwischen der Laktat-Clearance und der Sterblichkeit wurde analysiert und mit Hilfe der Empfänger-Charakteristik (ROC) wurden die Schwellenwerte für die Laktat-Clearance bestimmt; außerdem wurde eine logistische Regressionsanalyse durchgeführt, um festzustellen, ob LC ein unabhängiger Risikofaktor ist.Resultat Achtundsiebzig Patienten wurden berücksichtigt und die Gesamtmortalität betrug 13%. Die LC-Werte der Nichtüberlebenden waren signifikant niedriger als die der Überlebenden für LC0–2 h (28.60±14.26 versus 4.64±15.90), LC0–6 h (46,63±15,23 versus 3,33±18,07), LC0–12 h (56,97±15,53 versus 4,82±22,59) (p:<0.001, p:<0.001 und p:<0.001). Die Flächen unter der Kurve der Laktat-Clearance in der 2., 6. und 12. Stunde nach Therapiebeginn waren ein signifikanter Prädiktor für die Mortalität (p:<0.001, p:<0.001 und p:<0.001). Die LC-Schwellenwerte lagen bei 12.9, 19.5 und 29.3%.Schlussfolgerung Die Laktat-Clearance war ein nützliches Instrument zur Abschätzung der Folgen eines pädiatrischen Traumas. Eine schlechte Laktat-Clearance war ein signifikanter Marker für eine schlechte Prognose.

Keywords

Lactate - Lactate clearance - Pediatric - Trauma - Mortality

Schlüsselwörter

Laktat - Laktat-Clearance - Pädiatrie - Trauma - Sterblichkeitpublished online 2022

Publication History

Article published online:
15 November 2022

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