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J Pediatr Intensive Care 2022; 11(02): 083-090
DOI: 10.1055/s-0042-1743180
Review Article

Serum Lactate and Mortality during Pediatric Admissions: Is 2 Really the Magic Number?

Rohit S. Loomba 
1   Division of Pediatric Cardiac Critical Care, Advocate Children's Hospital, Oak Lawn, Illinois, United States
2   Department of Pediatrics, Chicago Medical School, Rosalind Franklin University of Medicine and Science, Chicago, Illinois, United States
,
Juan S. Farias 
3   Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo Leon, Mexico
,
Enrique G. Villarreal 
3   Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo Leon, Mexico
,
Saul Flores 
4   Section of Critical Care Medicine and Cardiology, Texas Children's Hospital, Houston, Texas, United States
5   Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States
› Author Affiliations Funding None.
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Abstract

The primary objective of this study was to determine if serum lactate level at the time of hospital admission can predict mortality in pediatric patients. A systematic review was conducted to identify studies that assessed the utility of serum lactate at the time of admission to predict mortality in pediatric patients. The areas under the curve from the receiver operator curve analyses were utilized to determine the pooled area under the curve. Additionally, standardized mean difference was compared between those who survived to discharge and those who did not. A total of 12 studies with 2,099 patients were included. Out of these, 357 (17%) experienced mortality. The pooled area under the curve for all patients was 0.74 (0.67–0.80, p < 0.01). The pooled analyses for all admissions were higher in those who experienced mortality (6.5 vs. 3.3 mmol/L) with a standardized mean difference of 2.60 (1.74–3.51, p < 0.01). The pooled area under the curve for cardiac surgery patients was 0.63 (0.53–0.72, p < 0.01). The levels for cardiac surgery patients were higher in those who experienced mortality (5.5 vs. 4.1 mmol/L) with a standardized mean difference of 1.80 (0.05–3.56, p = 0.04). Serum lactate at the time of admission can be valuable in identifying pediatric patients at greater risk for inpatient mortality. This remained the case when only cardiac surgery patients were included.

Keywords

lactic acid - pediatric - critical care - prognosis - mortality

Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.




Publication History

Received: 09 September 2021

Accepted: 06 January 2021

Article published online:
18 February 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Phypers B, Pierce JT. Lactate physiology in health and disease. Contin Educ Anaesth Crit Care Pain 2006; 6 (03) 128-132
    CrossrefPubMedGoogle Scholar
  • 2 Hernandez G, Bellomo R, Bakker J. The ten pitfalls of lactate clearance in sepsis. Intensive Care Med 2019; 45 (01) 82-85
    Google Scholar
  • 3 Andersen LW, Mackenhauer J, Roberts JC, Berg KM, Cocchi MN, Donnino MW. Etiology and therapeutic approach to elevated lactate levels. Mayo Clin Proc 2013; 88 (10) 1127-1140
    CrossrefPubMedGoogle Scholar
  • 4 Kraut JA, Madias NE. Lactic acidosis. N Engl J Med 2014; 371 (24) 2309-2319
    CrossrefPubMedGoogle Scholar
  • 5 Vincent J-L, Quintairos E Silva A, Couto Jr L, Taccone FS. The value of blood lactate kinetics in critically ill patients: a systematic review. Crit Care 2016; 20 (01) 257
    CrossrefPubMedGoogle Scholar
  • 6 Garcia-Alvarez M, Marik P, Bellomo R. Sepsis-associated hyperlactatemia. Crit Care 2014; 18 (05) 503
    CrossrefPubMedGoogle Scholar
  • 7 Broder G, Weil MH. Excess lactate: an index of reversibility of shock in human patients. Science 1964; 143 (3613): 1457-1459
    CrossrefPubMedGoogle Scholar
  • 8 Bakker J, Gris P, Coffernils M, Kahn RJ, Vincent JL. Serial blood lactate levels can predict the development of multiple organ failure following septic shock. Am J Surg 1996; 171 (02) 221-226
    CrossrefPubMedGoogle Scholar
  • 9 Kruse O, Grunnet N, Barfod C. Blood lactate as a predictor for in-hospital mortality in patients admitted acutely to hospital: a systematic review. Scand J Trauma Resusc Emerg Med 2011; 19 (01) 74
    CrossrefPubMedGoogle Scholar
  • 10 Martin J, Blobner M, Busch R, Moser N, Kochs E, Luppa PB. Point-of-care testing on admission to the intensive care unit: lactate and glucose independently predict mortality. Clin Chem Lab Med 2013; 51 (02) 405-412
    CrossrefPubMedGoogle Scholar
  • 11 Chebl RB, Tamim H, Dagher GA, Sadat M, Enezi FA, Arabi YM. Serum lactate as an independent predictor of in-hospital mortality in intensive care patients. J Intensive Care Med 2020; 35 (11) 1257-1264
    CrossrefPubMedGoogle Scholar
  • 12 Trzeciak S, Dellinger RP, Chansky ME. et al. Serum lactate as a predictor of mortality in patients with infection. Intensive Care Med 2007; 33 (06) 970-977
    CrossrefPubMedGoogle Scholar
  • 13 Shapiro NI, Howell MD, Talmor D. et al. Serum lactate as a predictor of mortality in emergency department patients with infection. Ann Emerg Med 2005; 45 (05) 524-528
    CrossrefPubMedGoogle Scholar
  • 14 Mikkelsen ME, Miltiades AN, Gaieski DF. et al. Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock. Crit Care Med 2009; 37 (05) 1670-1677
    CrossrefPubMedGoogle Scholar
  • 15 Bou Chebl R, El Khuri C, Shami A. et al. Serum lactate is an independent predictor of hospital mortality in critically ill patients in the emergency department: a retrospective study. Scand J Trauma Resusc Emerg Med 2017; 25 (01) 69
    CrossrefPubMedGoogle Scholar
  • 16 Nguyen HB, Rivers EP, Knoblich BP. et al. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med 2004; 32 (08) 1637-1642
    CrossrefPubMedGoogle Scholar
  • 17 Zhang Z, Xu X. Lactate clearance is a useful biomarker for the prediction of all-cause mortality in critically ill patients: a systematic review and meta-analysis*. Crit Care Med 2014; 42 (09) 2118-2125
    CrossrefPubMedGoogle Scholar
  • 18 Lu Y, Zhang H, Teng F, Xia WJ, Sun GX, Wen AQ. Early goal-directed therapy in severe sepsis and septic shock: a meta-analysis and trial sequential analysis of randomized controlled trials. J Intensive Care Med 2018; 33 (05) 296-309
    CrossrefPubMedGoogle Scholar
  • 19 Omar S, Burchard AT, Lundgren AC, Mathivha LR, Dulhunty JM. The relationship between blood lactate and survival following the use of adrenaline in the treatment of septic shock. Anaesth Intensive Care 2011; 39 (03) 449-455
    CrossrefPubMedGoogle Scholar
  • 20 Weiss SL, Peters MJ, Alhazzani W. et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Pediatr Crit Care Med 2020; 21 (02) e52-e106
    Google Scholar
  • 21 Scott HF, Brou L, Deakyne SJ, Fairclough DL, Kempe A, Bajaj L. Lactate clearance and normalization and prolonged organ dysfunction in pediatric sepsis. J Pediatr 2016; 170: 149-55 .e1, 4
    CrossrefPubMedGoogle Scholar
  • 22 Singer M, Deutschman CS, Seymour CW. et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315 (08) 801-810
    Google Scholar
  • 23 Cheung PY, Chui N, Joffe AR, Rebeyka IM, Robertson CM. Western Canadian Complex Pediatric Therapies Project, Follow-up Group. Postoperative lactate concentrations predict the outcome of infants aged 6 weeks or less after intracardiac surgery: a cohort follow-up to 18 months. J Thorac Cardiovasc Surg 2005; 130 (03) 837-843
    CrossrefPubMedGoogle Scholar
  • 24 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71
    Google Scholar
  • 25 Wells GASB, O'Connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2020 . Accessed January 20, 2022 at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
    PubMedGoogle Scholar
  • 26 Alam A, Gupta S. Lactate measurements and their association with mortality in pediatric severe sepsis in India: evidence that 6-hour level performs best. J Intensive Care Med 2021; 36 (04) 443-450
    CrossrefPubMedGoogle Scholar
  • 27 Bai Z, Zhu X, Li M. et al. Effectiveness of predicting in-hospital mortality in critically ill children by assessing blood lactate levels at admission. BMC Pediatr 2014; 14: 83
    Google Scholar
  • 28 Durward A, Tibby SM, Skellett S, Austin C, Anderson D, Murdoch IA. The strong ion gap predicts mortality in children following cardiopulmonary bypass surgery. Pediatr Crit Care Med 2005; 6 (03) 281-285
    CrossrefPubMedGoogle Scholar
  • 29 El-Mekkawy MS, Ellahony DM, Khalifa KAE, Abd Elsattar ES. Plasma lactate can improve the accuracy of the Pediatric Sequential Organ Failure Assessment Score for prediction of mortality in critically ill children: a pilot study. Arch Pediatr 2020; 27 (04) 206-211
    CrossrefPubMedGoogle Scholar
  • 30 Gupta A, Puliyel J, Garg B, Upadhyay P. Mean core to peripheral temperature difference and mean lactate levels in first 6 hours of hospitalisation as two indicators of prognosis: an observational cohort study. BMC Pediatr 2020; 20 (01) 515
    CrossrefPubMedGoogle Scholar
  • 31 Haidar MK, Morton N, Roederer T. et al. Evaluating lactate prognostic value in children suspected of acetaminophen-induced liver failure in Liberia. Pediatr Res 2020; 88 (04) 605-611
    CrossrefPubMedGoogle Scholar
  • 32 Hatherill M, Waggie Z, Purves L, Reynolds L, Argent A. Mortality and the nature of metabolic acidosis in children with shock. Intensive Care Med 2003; 29 (02) 286-291
    CrossrefPubMedGoogle Scholar
  • 33 Kapoor PM, Dhawan I, Jain P, Chowdhury U. Lactate, endothelin, and central venous oxygen saturation as predictors of mortality in patients with Tetralogy of Fallot. Ann Card Anaesth 2016; 19 (02) 269-276
    CrossrefPubMedGoogle Scholar
  • 34 Lee EP, Chu SC, Hsia SH. et al. Comparison of predictive powers for mortality between systemic vascular resistance index and serum lactate in children with persistent catecholamine-resistant shock. BioMed Res Int 2020; 2020: 1341326
    PubMedGoogle Scholar
  • 35 Ma C, Gunaratnam LC, Ericson A. et al. Handheld point-of-care lactate measurement at admission predicts mortality in Ugandan children hospitalized with pneumonia: a prospective cohort study. Am J Trop Med Hyg 2019; 100 (01) 37-42
    CrossrefPubMedGoogle Scholar
  • 36 Rocha TS, Silveira AS, Botta AM, Ricachinevsky CP, Dalle Mulle L, Nogueira A. Serum lactate as mortality and morbidity marker in infants after Jatene's operation. Rev Bras Cir Cardiovasc 2010; 25 (03) 350-358
    PubMedGoogle Scholar
  • 37 Consoli A, Nurjhan N, Reilly Jr JJ, Bier DM, Gerich JE. Contribution of liver and skeletal muscle to alanine and lactate metabolism in humans. Am J Physiol 1990; 259 (5 Pt 1): E677-E684
    PubMedGoogle Scholar
  • 38 Levy B, Desebbe O, Montemont C, Gibot S. Increased aerobic glycolysis through beta2 stimulation is a common mechanism involved in lactate formation during shock states. Shock 2008; 30 (04) 417-421
    CrossrefPubMedGoogle Scholar
  • 39 Connor H, Woods HF, Ledingham JG, Murray JD. A model of L(+)-lactate metabolism in normal man. Ann Nutr Metab 1982; 26 (04) 254-263
    CrossrefPubMedGoogle Scholar
  • 40 Levraut J, Ciebiera JP, Chave S. et al. Mild hyperlactatemia in stable septic patients is due to impaired lactate clearance rather than overproduction. Am J Respir Crit Care Med 1998; 157 (4 Pt 1): 1021-1026
    CrossrefPubMedGoogle Scholar
  • 41 Tapia P, Soto D, Bruhn A. et al. Impairment of exogenous lactate clearance in experimental hyperdynamic septic shock is not related to total liver hypoperfusion. Crit Care 2015; 19 (01) 188
    CrossrefPubMedGoogle Scholar
  • 42 Sterling SA, Puskarich MA, Jones AE. The effect of liver disease on lactate normalization in severe sepsis and septic shock: a cohort study. Clin Exp Emerg Med 2015; 2 (04) 197-202
    CrossrefPubMedGoogle Scholar
  • 43 Record CO, Chase RA, Williams R, Appleton D. Disturbances of lactate metabolism in patients with liver damage due to paracetamol overdose. Metabolism 1981; 30 (07) 638-643
    CrossrefPubMedGoogle Scholar
  • 44 Almenoff PL, Leavy J, Weil MH, Goldberg NB, Vega D, Rackow EC. Prolongation of the half-life of lactate after maximal exercise in patients with hepatic dysfunction. Crit Care Med 1989; 17 (09) 870-873
    CrossrefPubMedGoogle Scholar
  • 45 Vary TC, Siegel JH, Nakatani T, Sato T, Aoyama H. Effect of sepsis on activity of pyruvate dehydrogenase complex in skeletal muscle and liver. Am J Physiol 1986; 250 (6 Pt 1): E634-E640
    PubMedGoogle Scholar
  • 46 Hernandez G, Bruhn A, Castro R, Regueira T. The holistic view on perfusion monitoring in septic shock. Curr Opin Crit Care 2012; 18 (03) 280-286
    CrossrefPubMedGoogle Scholar
  • 47 Spiegel R, Gordon D, Marik PE. The origins of the Lacto-Bolo reflex: the mythology of lactate in sepsis. J Thorac Dis 2020; 12 (Suppl. 01) S48-S53
    CrossrefPubMedGoogle Scholar
  • 48 Marik P, Bellomo R. Lactate clearance as a target of therapy in sepsis: a flawed paradigm. OA Critical Care 2013; 1: 1
    CrossrefPubMedGoogle Scholar
  • 49 Siegel LB, Dalton HJ, Hertzog JH, Hopkins RA, Hannan RL, Hauser GJ. Initial postoperative serum lactate levels predict survival in children after open heart surgery. Intensive Care Med 1996; 22 (12) 1418-1423
    CrossrefPubMedGoogle Scholar
  • 50 Cheifetz IM, Kern FH, Schulman SR, Greeley WJ, Ungerleider RM, Meliones JN. Serum lactates correlate with mortality after operations for complex congenital heart disease. Ann Thorac Surg 1997; 64 (03) 735-738
    CrossrefPubMedGoogle Scholar
  • 51 Shemie SD. Serum lactate predicts postoperative complications after pediatric cardiac surgery. Pediatr Res 1996; 39 (04) 54-54
    CrossrefPubMedGoogle Scholar
  • 52 Duke T, Butt W, South M, Karl TR. Early markers of major adverse events in children after cardiac operations. J Thorac Cardiovasc Surg 1997; 114 (06) 1042-1052
    CrossrefPubMedGoogle Scholar
  • 53 Hatherill M, Sajjanhar T, Tibby SM. et al. Serum lactate as a predictor of mortality after paediatric cardiac surgery. Arch Dis Child 1997; 77 (03) 235-238
    CrossrefPubMedGoogle Scholar
  • 54 Charpie JR, Dekeon MK, Goldberg CS, Mosca RS, Bove EL, Kulik TJ. Serial blood lactate measurements predict early outcome after neonatal repair or palliation for complex congenital heart disease. J Thorac Cardiovasc Surg 2000; 120 (01) 73-80
    CrossrefPubMedGoogle Scholar
  • 55 Kalyanaraman M, DeCampli WM, Campbell AI. et al. Serial blood lactate levels as a predictor of mortality in children after cardiopulmonary bypass surgery. Pediatr Crit Care Med 2008; 9 (03) 285-288
    CrossrefPubMedGoogle Scholar
  • 56 Schumacher KR, Reichel RA, Vlasic JR. et al. Rate of increase in serum lactate level risk-stratifies infants after surgery for congenital heart disease. J Thorac Cardiovasc Surg 2014; 148 (02) 589-595
    CrossrefPubMedGoogle Scholar