Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2019 Oct;35(10):661-665.
doi: 10.1097/PEC.0000000000001021.

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

Noelle Gorgis  1 , Jeannette M Asselin  2 , Cynthia Fontana  2 , R Scott Heidersbach  3 , Heidi R Flori  4 , Shan L Ward  3   5
Affiliations
Observational Study

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

Noelle Gorgis et al. Pediatr Emerg Care. 2019 Oct.

Abstract

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.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest:

There are no conflicts of interest to disclose.

Figures

Figure 1
Figure 1. Scatter Plot of Lactate levels measured at time of severe sepsis or septic shock diagnosis (L0) and PRISM-III Score
Initial lactate levels correlated with PRISM-III score, a severity of illness score well validated for mortality prediction in pediatric critical illness, rho 0.33, p<0.01
See this image and copyright information in PMC

References

    1. Balamuth F, Weiss SL, Neuman MI, et al. Pediatric severe sepsis in U.S. children’s hospitals. Pediatr Crit Care Med. NIH Public Access. 2014 Nov 1;15(9):798–805. - PMC - PubMed
    1. Ruth A, McCracken CE, Fortenberry JD, et al. Pediatric severe sepsis: current trends and outcomes from the Pediatric Health Information Systems database. Pediatr Crit Care Med. 2014 Nov;15(9):828–38. - PubMed
    1. Hartman ME, Linde-Zwirble WT, Angus DC, Watson RS. Trends in the epidemiology of pediatric severe sepsis. Pediatr Crit Care Med. 2013 Sep;14(7):686–93. - PubMed
    1. Tiru B, DiNino EK, Orenstein A, et al. The Economic and Humanistic Burden of Severe Sepsis. Pharmacoeconomics. 2015 May 3;33(9):925–37. - PubMed
    1. Burchardi H, Schneider H. Economic aspects of severe sepsis: a review of intensive care unit costs, cost of illness and cost effectiveness of therapy. Pharmacoeconomics. 2004 Jan;22(12):793–813. - PubMed

Publication types

MeSH terms