Lactate Clearance and Normalization and Prolonged Organ Dysfunction in Pediatric Sepsis - 25/02/16
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Abstract |
Objectives |
To evaluate whether lactate clearance and normalization during emergency care of pediatric sepsis is associated with lower rates of persistent organ dysfunction.
Study design |
This was a prospective cohort study of 77 children <18 years of age in the emergency department with infection and acute organ dysfunction per consensus definitions. In consented patients, lactate was measured 2 and/or 4 hours after an initial lactate; persistent organ dysfunction was assessed through laboratory and physician evaluation at 48 hours. A decrease of ≥10% from initial to final level was considered lactate clearance; a final level <2 mmol/L was considered lactate normalization. Relative risk (RR) with 95% CIs, adjusted in a log-binomial model, was used to evaluate associations between lactate clearance/normalization and organ dysfunction.
Results |
Lactate normalized in 62 (81%) patients and cleared in 70 (91%). The primary outcome, persistent 48-hour organ dysfunction, was present in 32 (42%). Lactate normalization was associated with decreased risk of persistent organ dysfunction (RR 0.46, 0.29-0.73; adjusted RR 0.47, 0.29-0.78); lactate clearance was not (RR 0.70, 0.35-1.41; adjusted RR 0.75, 0.38-1.50). The association between lactate normalization and decreased risk of persistent organ dysfunction was retained in the subgroups with initial lactate ≥2 mmol/L and hypotension.
Conclusions |
In children with sepsis and organ dysfunction, lactate normalization within 4 hours was associated with decreased persistent organ dysfunction. Serial lactate level measurement may provide a useful prognostic tool during the first hours of resuscitation in pediatric sepsis.
Le texte complet de cet article est disponible en PDF.Keyword : ED, ICU, PELOD, REDCap, RR
Plan
Supported by the Thrasher Research Fund, Early Career Award (11363 [PI: H.S.]). The REDCap database used in this study is supported by Colorado Clinical & Translational Sciences Institute with the Development and Informatics Service Center by the National Institutes of Health/National Center for Research Resources (UL1 TR001082). The authors declare no conflicts of interest. |
Vol 170
P. 149 - mars 2016 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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