The relationship between blood lactate levels and mortality in pediatric intensive care patients

Year 2013, Volume: 4 Issue: 3, 269 - 273, 01.09.2013

İlyas Yolbaş Velat Şen Mehmet Boşnak Servet Yel Ali Güneş Selvi Kelekçi

https://doi.org/10.5799/ahinjs.01.2013.03.0282

Abstract

Objective: To determine relationship between blood lactate level and mortality rate in children admitted to the intensive care unit. Methods: 298 critically ill patients aged between 28 days and 16 years admitted to Dicle University Hospital, the third step Pediatric Intensive Care Unit in between January 2007 and December 2007 were included. Age, sex, diagnosis, Glasgow coma score points, the first measured blood lactate levels (lactate 1) and the arithmetic average of all measured blood lactate levels during treatment (lactate 2) of cases were evaluated. Patients were divided into group A (lactate < 20 mg/dl) and B (lactate &ge; 20 mg/dl). According to the results, patients were classified as survivors and non-survivors. Both lactate 1 and lactate 2 were compared with mortality rates. Results: In this study, a total of 298 patients were evaluated, 158 of them were nonsurvivors and 140 were survivors. A significant correlation was found between lactate levels and mortality rates. Lactate levels were higher in non-survivor cases (p

Keywords

Pediatric intensive care unit, critically ill children, blood lactate levels, mortality

Çocuk yoğun bakım hastalarında kan laktat düzeyleri ile mortalite arasındaki ilişki

Abstract

Amaç: Çocuk yoğun bakım servisinde takip edilen kritik hasta çocuklardaki kan laktat düzeyi ile mortalite arasındaki ilişkiyi belirlemek Yöntemler: Ocak 2007 ve Aralık 2007 tarihleri arasında Dicle Üniversitesi Tıp Fakültesi, üçüncü basamak Çocuk Yoğun Bakım Ünitesinde takip edilmiş, kritik hasta 28 günden büyük ve 16 yaşından küçük çocuklar seçildi. Hastaların yaşı, cinsiyeti, tanısı, Glasgow koma skorlaması puanı, ilk ölçülmüş kan laktat düzeyi (laktat 1) ve tedavi sırasında tüm ölçülmüş kan laktat düzeylerinin aritmetik ortalaması (laktat 2) verileri retrospektif olarak değerlendirildi. Hastalar; grup A (laktat &le;19 mg/dl) ve grup B (laktat &ge;20mg/dl) olarak iki gruba ayrıldı. Sonlanıma göre, hastalar yaşayanlar ve ölenler olarak iki gruba ayırıldı. Bu grupların mortalite oranları ve laktat düzeylerini karşılaştırıldı. Bulgular: Çalışmada; 140&#39;ı yaşamış ve 158&#39;i ölmüş olan toplam 298 vaka değerlendirildi. Laktat 1 ve laktat 2 seviyeleri ile mortalite arasında anlamlı bir ilişki bulundu. Ölen hastalarda laktat düzeyi anlamlı olarak daha yüksekti (p

Keywords

Çocuk yoğun bakım ünitesi, kritik hasta çocuk, kan laktat düzeyi, mortalite

References

• Sanz CG, Lucas MR, Cid JL, et al. Valor pronóstico de la puntuación PIM (índice pediátrico de mortalidad) y del ácido láctico en niños críticamente enfermos. An Esp Pediatr 2002;57:394-400.
• Robergs RA, Ghiasvand F, Parker D. Biochemistry of exercise-induced metabolic acidosis. Am J Physiol 2004;287:502-516.
• Gladden LB. Lactate metabolism: A new paradigm for the third millennium. J Physiol 2004;558:5-30.
• Rudinsky BF, Meadow WL. Relationship between oxy- gen delivery and metabolic acidosis during sepsis in piglets. Crit Care Med 1992;20:831-839.
• Meregalli A, Oliveira RP, Friedman G. Occult hypoper- fusion is associated with increase mortality in hemo- dynamically stable, high-risk, surgical patients. Criti- cal Care 2004;8:60-65.
• Jansen TC, van Bommel J, Woodward R, et al. As- sociation between blood lactate levels, Sequential Organ Failure Assessment subscores, and 28-day mortality during early and late intensive care unit stay: A retrospective observational study. Crit Care Med 2009;37:2369-2374.
• Cheung PY, Robertson CMT, Finer NN. Plasman lac- tate as a predictor of early childhood neurodevelop- mental outcome of neonates with severe hypoxemia requiring extracorporeal membrane oxygenation. 16. Mikkelsen ME, Miltiades AN, Gaieski DF, et al. Serum Arch Dis Child 1996;74:47-50.
• Smith I, Kumar P, Molloy S, et al. Base excess and lactate as prognostic indicators for patients admitted to intensive care. Intensive Care Med 2001;27:74-83.
• Nguyen HB, Rivers EP, Knoblich BP, et al. Early lac- tate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med 2004;32:1637-1642.
• Broder G, Weil MH: Excess lactate: An index of reversibility of shock in human patients. Science 1964;143:1457-1459
• Vincent JL, Dufaye P, Berre J, et al. Serial lactate de- terminations during circulatory shock. Crit Care Med 1983;11:449-451.
• Duke T, Butt W, South M, Karl TR. Early markers of major adverse events in children after cardiac opera- tions. J Thorac Cardiovasc Surg 1997;114:1042.
• Roumen RM, Redl H, Schlag G, et al. Scoring systems and blood lactate concentrations in relation to the de- velopment of adult respiratory distress syndrome and multiple organ failure in severely traumatized patients. J Trauma 1993;35:349-355.
• Bakker J, Gris P, Coffernils M, et al. Serial blood lactate levels can predict the development of mul- tiple organ failure following septic shock. Am J Surg 1996;171:221-226.
• M Hatherill, T Sajjanhar, S M Tibby, et al. Serum lac- tate as a predictor of mortality after paediatric cardiac surgery Arch Dis Child 1997;77:235-238.