A Retrospective Study on the Availability of Arterial Lactate Levels as a Biomarker of Mortality in Critically Ill Children

Öz

Objective: We aimed to determine the threshold value of lactate levels, and to analyze its avaliability as mortality biomarker by correlating it with scoring systems in pediatric intensive care unit (PICU). Material and Methods: Observational retrospective cohort study. Our study was conducted among patients admitted to the 24-bed tertiary PICU of our hospital in 2015. All children between the ages of 1 month and 18 years were evaluated. Among 433 patients whose arterial blood gases were obtained during hospitalization, a total of 382 were included in the study. Patients with congenital metabolic disease with lactic acidosis were excluded. The arterial blood lactate levels on admission, PIM-2, PRISM-III and PELOD scores and survival status of the patients were evaluated. Correlation between lactate levels and mortality scores, threshold values of lactate levels and the factors affecting mortality risk were the main variable of interest. Results: There was a significant correlation between lactate levels and scores in patients who died (p<0.001). Receiver operating characteristic (ROC) curve analysis showed that blood lactate level was an effective parameter on mortality (area under the curve=AUC: 0.861; p<0.001) with a cut-off value of 2.55 mmol/L. The mortality risk was 1.38 fold higher in patients with higher levels of lactate. Conclusion: In our series, the levels of lactate were higher in critically ill children who died. Again, lactate levels and mortality scores of these children were correlated. In our series, the levels of lactate were higher in critically ill children who died. Again, lactate levels and mortality scores of these children were correlated. We were able to establish a cut-off point with high specificity for predicting evolution. These findings should be validated in prospective and multicenter studies for their incorporation into scoring systems.

Anahtar Kelimeler

• Lactate
• Mortality
• Pediatric intensive care
• PELOD
• PIM-2
• PRISM-III

Kritik Hasta Çocuklarda Arteriyel Laktat Düzeylerinin Mortalite Biyobelirteci Olarak Kullanılabilirliğine İlişkin Retrospektif Bir Çalışma

Öz

Amaç: Çocuk yoğun bakım ünitesinde (ÇYBÜ) laktat düzeylerinin eşik değerini belirlemeyi ve bunun mortalite biyobelirteci olarak kullanımının skorlama sistemleriyle korelasyonunu analiz etmeyi amaçladık. Gereç ve Yöntemler: Gözlemsel retrospektif bir kohort çalışmasıdır. Çalışmamız 2015 yılında hastanemizin 24 yataklı üçüncü basamak ÇYBÜ’sine başvuran hastalar arasında yapılmıştır. 1 ay-18 yaş arasındaki tüm çocuklar değerlendirildi. Yatış sürecinde takipte arteriyel kan gazı alınan 433 hastanın 382’si çalışmaya alındı. Laktik asidozlu konjenital metabolik hastalığı olan hastalar çalışma dışı bırakıldı. Hastaların başvuru anında alınan arteriyel kan laktat düzeyleri, PIM-2, PRISM-III, PELOD skorları ve hastaların sağkalım durumları değerlendirildi. Laktat seviyeleri ile mortalite skorları arasındaki korelasyon, laktat seviyelerinin eşik değerleri ve mortalite riskini etkileyen faktörler ana değişkenlerdi. Bulgular: Ölen hastaların laktat düzeyleri ile mortalite skorları arasında anlamlı bir ilişki vardı (p<0.001). ROC eğrisi analizinde kan laktat düzeylerinin mortalite üzerinde etkili bir parametre olduğu (eğri altındaki alan=AUC: 0.861; p<0.001) ve eşik değeri 2.55 mmol/L olarak bulundu. Laktat düzeyi yüksek olan hastalarda ölüm riski 1.38 kat daha fazlaydı. Sonuç: Mortalite olan kritik çocuklar hastalarda laktat düzeyleri daha yüksekti. Aynı çocukların laktat seviyeleri ve mortalite skorları korele edildi. Tanımladığımız eşik değerlerin üzerinde mortalitenin arttığı görüldü. Bu bulguların skorlama sistemlerine dahil edilebilmesi için prospektif ve çok merkezli daha fazla çalışma ile doğrulanması gerekmektedir.

Anahtar Kelimeler

• Laktat
• Mortalite
• Pediatrik yoğun bakım
• PELOD
• PIM-2
• PRISM-III

Kaynakça

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