11 Jan Elevated Lactate Linked To Increased Mortality in Children With Sepsis
MedicalResearch.com Interview with:
Halden F. Scott MD, Assistant Professor
Departments of Pediatrics and Emergency Medicine
University of Colorado School of Medicine
MedicalResearch.com: What is the background for this study?
Response: Sepsis, a dysregulated immune response to infection, is a leading cause of death for children. Survival depends on rapid diagnosis and timely delivery of life-saving resuscitative care, including fluids and antibiotics. However, it can be challenging to make an early diagnosis of sepsis in children.
Millions of children present for emergency care of infection and fever every year, most of whom will not develop sepsis. Tools that assist providers in distinguishing the sickest children with infection at an early stage could enable the early delivery of life-saving treatments.
Lactate is a clinically-available laboratory test that has played a critical role in improving the diagnosis and treatment of sepsis in adults. Sepsis may cause lactate levels to rise in the blood during sepsis, through reduced delivery of oxygen to the tissues, as well as through changes in how energy is produced and in how lactate is cleared by the kidney and liver. Data about lactate in pediatric sepsis, particularly early levels and whether it is associated with mortality, have been limited.
MedicalResearch.com: What are the main findings?
Response: In our study, we demonstrated that elevated early lactate levels (> 4 mmol/L) are associated with a higher risk of in-hospital mortality in children in whom clinicians suspected sepsis. In addition, we showed that other important outcomes, such as endotracheal intubation, vasoactive agent use, and prolonged hospital length of stay were more common in patients with elevated lactate levels. Lactate was measured an average of 24 minutes after patients arrived in the emergency department in this study.
Our study was unique in demonstrating an association between lactate measured at a very early stage and mortality, in a cohort of children whose severity of illness was somewhat undifferentiated. Prior studies have focused on children with known organ dysfunction or in intensive care units. In our study, patients were initially identified by physicians and nurses as showing concerning signs of early sepsis, but organ dysfunction or critical care needs were not yet fully known.
MedicalResearch.com: What should readers take away from your report?
Response: There are two important clinical messages of this study.
First, an elevated lactate is associated with increased risk of mortality and other severe outcomes in children with clinically-suspected sepsis. This may make it useful in detecting patients earlier, or alerting clinicians that a patient has more severe illness than they initially appreciated.
Secondly, and importantly, lactate is not sensitive, meaning that it was not elevated in many patients who did have severe illness, which is why we would not recommend that it be used alone as a screening test to detect sepsis in children. Diagnosis and treatment decisions were made by the physicians of the patients in this study according to their own clinical judgment, which included knowledge of the lactate level and all of the other clinical factors related to the patient, including medical history, physical exam findings, vital signs and laboratory results.
Lactate is a practical test. It is widely available, and levels are dynamic, changing over time as a patient’s condition changes, which makes it particularly useful to the bedside clinician. It should be considered for use in conjunction with other clinical patient information in assessing a child’s severity of illness, and may be useful to include in institutional sepsis care pathways for children.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Lactate is one important early prognostic marker in children with clinically-suspected sepsis, but is not an ideal stand-alone diagnostic tool. Research to improve early diagnosis of pediatric sepsis, integrating potentially predictive variables and exploring new pre-clinical markers, is critical. We also do not know whether the use of lactate testing as part of a comprehensive sepsis care bundle improves outcomes in children. These will be important directions for future research.
MedicalResearch.com: Is there anything else you would like to add?
Response: I have no disclosures or conflicts of interest.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Scott HF, Brou L, Deakyne SJ, Kempe A, Fairclough DL, Bajaj L. Association Between Early Lactate Levels and 30-Day Mortality in Clinically Suspected Sepsis in Children. JAMA Pediatr. Published online January 09, 2017. doi:10.1001/jamapediatrics.2016.3681
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