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

Plasma lactate has been used to predict the prognosis of critically ill children, but mortality risk scores appear to be more appealing, particularly in resource-limited countries. To assess the prognostic utility of lactate compared with the pediatric Sequential Organ Failure Assessment (pSOFA) sco...

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Published in:Archives de pédiatrie : organe officiel de la Société française de pédiatrie 2020-05, Vol.27 (4), p.206-211
Main Authors: El-Mekkawy, M.S., Ellahony, D.M., Khalifa, K.A.E., Abd Elsattar, E.S.
Format: Article
Language:English
Subjects:
Adolescent
Biomarkers - blood
Child
Child, Preschool
Clinical Decision Rules
Critical Illness - mortality
Critically ill children
Female
Humans
Infant
Lactate
Lactic Acid - blood
Logistic Models
Male
Mortality
Multiple Organ Failure - blood
Multiple Organ Failure - diagnosis
Multiple Organ Failure - mortality
Organ Dysfunction Scores
Pediatric
Pilot Projects
Prognosis
Prospective Studies
Sequential Organ Failure Assessment Score
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Summary:Plasma lactate has been used to predict the prognosis of critically ill children, but mortality risk scores appear to be more appealing, particularly in resource-limited countries. To assess the prognostic utility of lactate compared with the pediatric Sequential Organ Failure Assessment (pSOFA) score among the general pediatric intensive care unit (PICU) population. This was a prospective observational study including 78 children admitted to a tertiary-level PICU. Plasma lactate was measured upon admission and repeated 24h later. pSOFA score, Pediatric Risk of Mortality, and Pediatric Index of Mortality-2 (PIM2) were calculated. The primary outcome was 30-day mortality. In total, 47.4% of patients had hyperlactatemia at admission. Among these, 20.5% had persistent hyperlactatemia. No significant difference in admission lactate level was found between survivors and nonsurvivors. The 24-h, peak, and average lactate levels were higher among nonsurvivors (P=0.005, 0.035, and 0.019, respectively). The 24-h lactate level and pSOFA score were independent predictors of mortality (adjusted odds ratio and 95% confidence interval=1.12 [1.02–1.23] and 1.80 [1.23–2.64], respectively]. The 24-h lactate level showed positive correlations with pSOFA, PRISM, and PIM2 (Spearman correlation coefficient=0.31, 0.23, 0.43; P=0.006, P=0.047, P
ISSN:0929-693X
1769-664X
DOI:10.1016/j.arcped.2020.03.004