The The Role of Lactate Level as Predictor of Mortality Critically Ill Children at Moewardi Hospital

Authors

  • Reza Ervanda Zilmi Department of Pediatrics, Sebelas Maret University/ Dr. Moewardi General Hospital, Surakarta
  • Pudjiastuti Pudjiastuti Department of Pediatrics, Sebelas Maret University/ Dr. Moewardi General Hospital, Surakarta
  • Rustam Siregar Department of Pediatrics, Sebelas Maret University/ Dr. Moewardi General Hospital, Surakarta

DOI:

https://doi.org/10.26911/thejmch.2024.09.01.08

Abstract

Background: The prevalence of mortality among critically ill children worldwide, particularly in Indonesia, remains alarmingly high. Numerous studies have indicated that elevated lactate levels serve as a significant predictor of mortality in this vulnerable population. The primary objective of this study is to elucidate the predictive value of lactate levels in determining mortality risk among critically ill children.

Subjects and Method: A cohort prospective study was conducted in children aged between 1 month and 18 years old who met the criteria for critically ill children treated in the Pediatric High care unit (PHCU) of Dr. Moewardi General Hospital, Surakarta from January to June 2023. The dependent variable was the mortality. The independent variable was lactate level serum. The data were collected using questionnaire and observation sheet. The cut off point of lactate level was determined with  ROC curve.

Results: Among thirty critically ill pediatric patients, 43.3% died, while 56.7% survived. The deceased predominantly comprised females, with a mean age of 5.62 years (SD= 4.14). The mean lactate levels of those who died in the first hour, 6 hours, and 24 hours (Mean= 2.94; SD= 0.90) with a cut-off value of ≥2.35 mmol/L, (Mean= 3.20; SD= 0.50) with a cut-off value of ≥ 2.35 mmol/L and (Mean= 3.65; SD= 0.53) with a cut-off value of ≥2.95 mmol/L, respectively. The 24th hours lactate levels (persistence hyperlactatemia) had the highest sensitivity (92.3%) and specificity (100%) for predicting mortality (p<0.001).

Conclusion: In critically ill children, lactate level of ≥2.95 mmol/L is a good predictor of mortality.

Keywords:

lactate level, mortality, critically ill children

References

Bai Z, Zhu X, Li M, Hua J, Li Y, Pan J, Wang J, et al. (2014). Effectiveness of predicting in-hospital mortality in critically ill children by assessing blood lactate levels at admission. BMC Pediatr. 14(1):1–9.doi:10.1186/147124311483

Bramantyo TB, Martuti S, Salimo H (2018). Perbandingan prediktor mortalitas skor PRISM III dan PELOD-2 pada anak sakit kritis non bedah (Perbandingan prediktor mortalitas skor PRISM III dan PELOD-2 pada anak sakit kritis non bedah). Sari Pediatr. 19(5): 284-289. doi: 10.14238/sp19.5.2018.284-9

Dewi R, Fatimatuzzuhroh (2019). Profil pasien sakit kritis yang dirawat di pediatric intensive care unit Rumah Sakit Cipto Mangunkusumo berdasar sistem skoring pediatric logistic organ dysfunction-2 (Profile of critically ill patients treated in the pediatric intensive care unit at Cipto Mangunkusumo Hospital based on the pediatric logistic organ dysfunction -2 scoring system). Sari Pediatr. 21(1):37–43. doi: 10.14238/sp21.1.2019.37-43

Dharma AB, Rosalina I, Sekarwana N (2008). Hubungan kadar laktat plasma dengan derajat disfungsi organ berdasarkan skor PELOD pada anak sakit kritis (The relationship between plasma lactate levels and the degree of organ dysfunction based on the PELOD score in critically ill children). Sari Pediatr. 10(4):280-284. doi: 10.14238/sp10.4.2008.2804.

Guideline U (2016). Paediatric emergency triage, assessment and treatment. Pediatr Emetgency Triagr, Assesment Treat Crit Ill Child. 2016. [accessed date August 10 th,2022]. Avalilable in ://www.who.int/publications/i/item/9789241510219

Gunawan PY, Runtunuwu AL, Mandei JM, Manoppo JIC, Saputra DK (2017). Hubungan kadar laktat serum inisial dan skor pelod pada anak dengan sepsis (Relationship between initial serum lactate levels and pelod scores in children with sepsis). Sari Pediatr. 18(3):192-197. doi: 10.14238/sp18.3.2016.1927

Molina-Hazan V, Paret G (2012). The physiology and the clinical significance of postoperative hyperlactatemia after pediatric cardiac surgery. In : Narin C, editor. Perioper Considerations Card Surg.Croatia; 2012. p. 307-320.

Meher BK, Sahoo D, Pradhan DD, Satpathy SK, Nayak AS (2018). Hyperlactatemia in critically ill children: the clinical value of lactate for predicting mortality in the pediatric intensive care unit. J Pediatr Crit Care. 5(1):29-35. doi: 10.21304/2018.0501.00361

Patki V, Antin J, Khare S (2017). Persistent hyperlactatemia as the predictor of poor outcome in critically ill children: a single-center, prospective, observational cohort study. J Pediatr Intensive Care. 6(03):152–158. doi: 10.1055/s00361593886.

Pollack MM, Holubkov R, Funai T, Dean JM, Berger JT, Wessel DL, Meert K, et al (2016). The pediatric risk of mortality score: update 2015. Pediatr Crit Care Med. 17(1):2–9. doi: 10.1097/PCC.0000000000000558

Downloads

Published

2024-01-16

How to Cite

Zilmi, R. E., Pudjiastuti, P., & Siregar, R. (2024). The The Role of Lactate Level as Predictor of Mortality Critically Ill Children at Moewardi Hospital. Journal of Maternal and Child Health, 9(1), 89–96. https://doi.org/10.26911/thejmch.2024.09.01.08

Issue

Section

Articles