The Relationship Between Blood Lactate Concentration, the Paediatric Index of Mortality 2 (PIM2) and Mortality in Paediatric Intensive Care

Overview

Journal Intensive Care Med

Specialty Critical Care

Date 2012 Oct 27

PMID 23100008

Citations 9

Authors

Kevin P Morris

Phil McShane

John Stickley

Roger C Parslow

Affiliations

Soon will be listed here.

Abstract

Introduction: Blood lactate concentration predicts mortality in neonates, infants, children and adults, with evidence that it has better predictive power than other markers of acid-base status such as absolute base excess or pH.

Objective: To investigate whether blood lactate concentration on admission predicts mortality in paediatric intensive care and if its addition can improve the performance of the Paediatric Index of Mortality 2 (PIM2) mortality prediction score.

Design And Setting: Retrospective cohort study in one 20-bed UK paediatric intensive care unit (PICU) using data from the PICU clinical and blood gas analyser databases between 2006 and 2010. Only cases with a blood lactate concentration measured at the same time as the PIM2 variables were included. Logistic regression was used to assess if blood lactate concentration predicted mortality independently of PIM2, adjusting for potential confounders, and if it could replace absolute base excess in the PIM2 model.

Results: There were 155 deaths amongst 2,380 admissions (6.5 %). Admission lactate in non-survivors was higher than in survivors (mean [standard deviation, SD]) 6.6 [5.6] versus 3.0 [2.5] mmol/l, had a positive association with mortality [adjusted odds ratio (OR) for death per unit (mmol/l)] increase 1.11 [95 % confidence interval (CI) 1.06-1.16; p < 0.001] and significantly improved the model fit of PIM2 when it replaced absolute base excess (p < 0.001).

Conclusions: PICU admission blood lactate concentration predicts mortality independently of PIM2. Given the limitations of this study, a prospective multi-centre evaluation is required to establish whether it should be added to the PIM2 model with or without replacement of base excess.

Citing Articles

Exploring the risks of cefepime in acute kidney injury for pediatric and young adult critical care.

Tang W, Deng W, Liu T Pediatr Nephrol. 2024; .

PMID: 39352480 DOI: 10.1007/s00467-024-06542-y.

Post hospital admission blood lactate measurements are associated with mortality but not neurologic morbidity in children with cerebral malaria.

Olowojesiku R, Sherman M, Mukadam A, Imam R, Chastang K, Seydel K Malar J. 2024; 23(1):28.

PMID: 38243243 PMC: 10797711. DOI: 10.1186/s12936-024-04843-z.

Association between Serum Lactate and Morbidity and Mortality in Neonates: A Systematic Review and Meta-Analysis.

Matsushita F, Krebs V, Brunow de Carvalho W Children (Basel). 2023; 10(11).

PMID: 38002887 PMC: 10670916. DOI: 10.3390/children10111796.

A DIFFERENT PERSPECTIVE OF ELEVATED LACTATE IN PEDIATRIC PATIENTS WITH DIABETIC KETOACIDOSIS.

Unal E, Pirinccioglu A, Yanmaz S, Yilmaz K, Taskesen M, Haspolat Y Acta Endocrinol (Buchar). 2020; 16(1):114-117.

PMID: 32685051 PMC: 7363999. DOI: 10.4183/aeb.2020.114.

Prediction of pediatric sepsis mortality within 1 h of intensive care admission.

Schlapbach L, MacLaren G, Festa M, Alexander J, Erickson S, Beca J Intensive Care Med. 2017; 43(8):1085-1096.

PMID: 28220227 DOI: 10.1007/s00134-017-4701-8.

References

Bakker J, Coffernils M, Leon M, Gris P, Vincent J . Blood lactate levels are superior to oxygen-derived variables in predicting outcome in human septic shock. Chest. 1991; 99(4):956-62. DOI: 10.1378/chest.99.4.956. View

Vincent J . Lactate levels in critically ill patients. Acta Anaesthesiol Scand Suppl. 1995; 107:261-6. DOI: 10.1111/j.1399-6576.1995.tb04368.x. View

Garcia Sanz C, Ruperez Lucas M, Lopez-Herce Cid J, Vigil Escribano D, Garrido Cantarero G . [Prognostic value of the pediatric index of mortality (PIM) score and lactate values in critically-ill children]. An Esp Pediatr. 2002; 57(5):394-400. View

Pollack M, Patel K, Ruttimann U . PRISM III: an updated Pediatric Risk of Mortality score. Crit Care Med. 1996; 24(5):743-52. DOI: 10.1097/00003246-199605000-00004. View

Pollack M, Ruttimann U, Getson P . Pediatric risk of mortality (PRISM) score. Crit Care Med. 1988; 16(11):1110-6. DOI: 10.1097/00003246-198811000-00006. View

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(2):286-91. DOI: 10.1007/s00134-002-1585-y. View

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; 19:74. PMC: 3292838. DOI: 10.1186/1757-7241-19-74. View

Phillips L, Dewhurst C, Yoxall C . The prognostic value of initial blood lactate concentration measurements in very low birthweight infants and their use in development of a new disease severity scoring system. Arch Dis Child Fetal Neonatal Ed. 2010; 96(4):F275-80. DOI: 10.1136/adc.2010.185793. View

Frey B, Losa M . The value of capillary whole blood lactate for blood transfusion requirements in anaemia of prematurity. Intensive Care Med. 2001; 27(1):222-7. DOI: 10.1007/s001340000712. View

10.

Jansen T, Van Bommel J, Schoonderbeek F, Sleeswijk Visser S, van der Klooster J, Lima A . Early lactate-guided therapy in intensive care unit patients: a multicenter, open-label, randomized controlled trial. Am J Respir Crit Care Med. 2010; 182(6):752-61. DOI: 10.1164/rccm.200912-1918OC. View

11.

Deshpande S, Platt M . Association between blood lactate and acid-base status and mortality in ventilated babies. Arch Dis Child Fetal Neonatal Ed. 1997; 76(1):F15-20. PMC: 1720617. DOI: 10.1136/fn.76.1.f15. View

12.

Weil M, Afifi A . Experimental and clinical studies on lactate and pyruvate as indicators of the severity of acute circulatory failure (shock). Circulation. 1970; 41(6):989-1001. DOI: 10.1161/01.cir.41.6.989. View

13.

Slater A, Shann F, Pearson G . PIM2: a revised version of the Paediatric Index of Mortality. Intensive Care Med. 2003; 29(2):278-85. DOI: 10.1007/s00134-002-1601-2. View

14.

Shann F, Pearson G, Slater A, Wilkinson K . Paediatric index of mortality (PIM): a mortality prediction model for children in intensive care. Intensive Care Med. 1997; 23(2):201-7. DOI: 10.1007/s001340050317. View

15.

Parslow R, Tasker R, Draper E, Parry G, Jones S, Chater T . Epidemiology of critically ill children in England and Wales: incidence, mortality, deprivation and ethnicity. Arch Dis Child. 2008; 94(3):210-5. DOI: 10.1136/adc.2007.134403. View

16.

Duke T, Butt W, South M . Predictors of mortality and multiple organ failure in children with sepsis. Intensive Care Med. 1997; 23(6):684-92. DOI: 10.1007/s001340050394. View

17.

Murdoch I, Turner C, Dalton R . Arterial or mixed venous lactate measurement in critically ill children. Is there a difference?. Acta Paediatr. 1994; 83(4):412-3. DOI: 10.1111/j.1651-2227.1994.tb18131.x. View

18.

Hatherill M, McIntyre A, Wattie M, Murdoch I . Early hyperlactataemia in critically ill children. Intensive Care Med. 2000; 26(3):314-8. DOI: 10.1007/s001340051155. View