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Early lactate levels may help identify at-risk children with suspected sepsis
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Initial lactate levels greater than 36 mg/dL were significantly associated with increased mortality in children treated for sepsis in the ED, according to the results of an observational cohort study in Colorado.
“To our knowledge, lactate levels had not previously been tested for an association with mortality in an ED cohort where mortality due to pediatric sepsis is substantially lower than in the ICU,” Halden F. Scott, MD, assistant professor in the department of pediatrics at the University of Colorado, Aurora, and medical director of the sepsis treatment and recognition program at Children’s Hospital Colorado, and colleagues wrote in JAMA Pediatrics.
“This study of lactate levels early in ED care is important because the first hours of sepsis care are critical to the outcome,” the researchers wrote. “Lactate levels were measured a mean of less than 30 minutes after ED arrival, when the procedure may be most useful.”
Scott and colleagues analyzed patient data from the Colorado Sepsis Treatment and Recognition Registry from April 1, 2012, through Dec. 31, 2015. They included patients whose venous lactate levels were measured within 8 hours of arrival in the ED and excluded any patients aged younger than 60 days or older than 18 years, and those transferred from another medical facility.
Of the 1,299 patients included in the analysis, 58% were boys and the mean age was 7.3 years. Nearly 70% of the patients had chronic medical conditions and 28.3% had acute organ dysfunction. The median lactate level was 14.4 mg/dL. In survivors, lactate levels were measured a median of 24 minutes after arrival in the ED; in nonsurvivors, the median was 21 minutes.
In all, 1.9% of patients (n = 25) died within 30 days. This included 4.8% of the 103 patients with lactate levels greater than 36 mg/dL and 1.7% of the 1,196 patients with lactate levels under 36 mg/dL.
According to Scott and colleagues, the review showed that initial lactate levels greater than 36 mg/dL were “significantly” associated with 30-day mortality in both unadjusted (OR = 3; 95% CI, 1.1-8.17) and adjusted (OR = 3.26; 95% CI, 1.16-9.16) analyses. The sensitivity of lactate levels over 36 mg/dL was 20% (95% CI, 8.9-39.1) and specificity was 92.3% (95% CI, 90.7-93.7).
Scott and colleagues said their study does not suggest a causal association between lactate levels and mortality, but that measurement of lactate levels may be used by physicians to help identify patients at risk.
“This study found that lactate levels are a low-sensitivity and high-specificity test for mortality. Lactate levels alone would thus not be an effective screening test for the rare and temporally distant event of mortality,” they wrote. “Although lactate levels were associated with an increased risk for mortality, most patients in the study with elevated lactate levels survived. Rather than as a screening test, lactate levels might best be used to identify the highest-risk patients among those in whom the treating clinician has already identified a potential clinical concern for sepsis.” – by Gerard Gallagher
Disclosure: The researchers report no relevant financial disclosures.
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