Plasma lactate can improve the accuracy of the Pediatric Sequential Organ Failure Assessment Score for prediction of mortality in critically ill children: A pilot study
Plasma lactate has been used to predict the prognosis of critically ill children, but mortality risk scores appear to be more appealing, particularly in resource-limited countries. To assess the prognostic utility of lactate compared with the pediatric Sequential Organ Failure Assessment (pSOFA) sco...
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| Veröffentlicht in: | Archives de pédiatrie : organe officiel de la Société française de pédiatrie 2020-05, Vol.27 (4), p.206-211 |
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| creator | El-Mekkawy, M.S. Ellahony, D.M. Khalifa, K.A.E. Abd Elsattar, E.S. |
| description | Plasma lactate has been used to predict the prognosis of critically ill children, but mortality risk scores appear to be more appealing, particularly in resource-limited countries.
To assess the prognostic utility of lactate compared with the pediatric Sequential Organ Failure Assessment (pSOFA) score among the general pediatric intensive care unit (PICU) population.
This was a prospective observational study including 78 children admitted to a tertiary-level PICU. Plasma lactate was measured upon admission and repeated 24h later. pSOFA score, Pediatric Risk of Mortality, and Pediatric Index of Mortality-2 (PIM2) were calculated. The primary outcome was 30-day mortality.
In total, 47.4% of patients had hyperlactatemia at admission. Among these, 20.5% had persistent hyperlactatemia. No significant difference in admission lactate level was found between survivors and nonsurvivors. The 24-h, peak, and average lactate levels were higher among nonsurvivors (P=0.005, 0.035, and 0.019, respectively). The 24-h lactate level and pSOFA score were independent predictors of mortality (adjusted odds ratio and 95% confidence interval=1.12 [1.02–1.23] and 1.80 [1.23–2.64], respectively]. The 24-h lactate level showed positive correlations with pSOFA, PRISM, and PIM2 (Spearman correlation coefficient=0.31, 0.23, 0.43; P=0.006, P=0.047, P |
| doi_str_mv | 10.1016/j.arcped.2020.03.004 |
| format | Article |
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To assess the prognostic utility of lactate compared with the pediatric Sequential Organ Failure Assessment (pSOFA) score among the general pediatric intensive care unit (PICU) population.
This was a prospective observational study including 78 children admitted to a tertiary-level PICU. Plasma lactate was measured upon admission and repeated 24h later. pSOFA score, Pediatric Risk of Mortality, and Pediatric Index of Mortality-2 (PIM2) were calculated. The primary outcome was 30-day mortality.
In total, 47.4% of patients had hyperlactatemia at admission. Among these, 20.5% had persistent hyperlactatemia. No significant difference in admission lactate level was found between survivors and nonsurvivors. The 24-h, peak, and average lactate levels were higher among nonsurvivors (P=0.005, 0.035, and 0.019, respectively). The 24-h lactate level and pSOFA score were independent predictors of mortality (adjusted odds ratio and 95% confidence interval=1.12 [1.02–1.23] and 1.80 [1.23–2.64], respectively]. The 24-h lactate level showed positive correlations with pSOFA, PRISM, and PIM2 (Spearman correlation coefficient=0.31, 0.23, 0.43; P=0.006, P=0.047, P<0.001, respectively). The 24-h lactate level had an area under the receiver operating characteristic curve (AUC) of 0.77 (P=0.013) for mortality prediction, while admission, peak, and average lactate level had an AUC of 0.69, 0.69, 0.71 (P=0.086, P=0.035, P=0.019), respectively. PIM2, PRISM, and pSOFA score had an AUC of 0.80, 0.78, 0.82 (P=0.001, P=0.001, and P<0.001), respectively. Combining 24-h lactate level with pSOFA demonstrated superior performance (AUC=0.88).
Both 24-h lactate level and pSOAF are useful for prediction of mortality. Incorporating the 24-h lactate level into the pSOFA Score achieved superior prognostic utility.</description><identifier>ISSN: 0929-693X</identifier><identifier>EISSN: 1769-664X</identifier><identifier>DOI: 10.1016/j.arcped.2020.03.004</identifier><identifier>PMID: 32278589</identifier><language>eng</language><publisher>France: Elsevier Masson SAS</publisher><subject>Adolescent ; Biomarkers - blood ; Child ; Child, Preschool ; Clinical Decision Rules ; Critical Illness - mortality ; Critically ill children ; Female ; Humans ; Infant ; Lactate ; Lactic Acid - blood ; Logistic Models ; Male ; Mortality ; Multiple Organ Failure - blood ; Multiple Organ Failure - diagnosis ; Multiple Organ Failure - mortality ; Organ Dysfunction Scores ; Pediatric ; Pilot Projects ; Prognosis ; Prospective Studies ; Sequential Organ Failure Assessment Score</subject><ispartof>Archives de pédiatrie : organe officiel de la Société française de pédiatrie, 2020-05, Vol.27 (4), p.206-211</ispartof><rights>2020 French Society of Pediatrics</rights><rights>Copyright © 2020 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c362t-6d0c53fd3a20a5ab7aa4c7c680231c010a446bbeac51e1f92bb279807c8809dc3</citedby><cites>FETCH-LOGICAL-c362t-6d0c53fd3a20a5ab7aa4c7c680231c010a446bbeac51e1f92bb279807c8809dc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.arcped.2020.03.004$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32278589$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>El-Mekkawy, M.S.</creatorcontrib><creatorcontrib>Ellahony, D.M.</creatorcontrib><creatorcontrib>Khalifa, K.A.E.</creatorcontrib><creatorcontrib>Abd Elsattar, E.S.</creatorcontrib><title>Plasma lactate can improve the accuracy of the Pediatric Sequential Organ Failure Assessment Score for prediction of mortality in critically ill children: A pilot study</title><title>Archives de pédiatrie : organe officiel de la Société française de pédiatrie</title><addtitle>Arch Pediatr</addtitle><description>Plasma lactate has been used to predict the prognosis of critically ill children, but mortality risk scores appear to be more appealing, particularly in resource-limited countries.
To assess the prognostic utility of lactate compared with the pediatric Sequential Organ Failure Assessment (pSOFA) score among the general pediatric intensive care unit (PICU) population.
This was a prospective observational study including 78 children admitted to a tertiary-level PICU. Plasma lactate was measured upon admission and repeated 24h later. pSOFA score, Pediatric Risk of Mortality, and Pediatric Index of Mortality-2 (PIM2) were calculated. The primary outcome was 30-day mortality.
In total, 47.4% of patients had hyperlactatemia at admission. Among these, 20.5% had persistent hyperlactatemia. No significant difference in admission lactate level was found between survivors and nonsurvivors. The 24-h, peak, and average lactate levels were higher among nonsurvivors (P=0.005, 0.035, and 0.019, respectively). The 24-h lactate level and pSOFA score were independent predictors of mortality (adjusted odds ratio and 95% confidence interval=1.12 [1.02–1.23] and 1.80 [1.23–2.64], respectively]. The 24-h lactate level showed positive correlations with pSOFA, PRISM, and PIM2 (Spearman correlation coefficient=0.31, 0.23, 0.43; P=0.006, P=0.047, P<0.001, respectively). The 24-h lactate level had an area under the receiver operating characteristic curve (AUC) of 0.77 (P=0.013) for mortality prediction, while admission, peak, and average lactate level had an AUC of 0.69, 0.69, 0.71 (P=0.086, P=0.035, P=0.019), respectively. PIM2, PRISM, and pSOFA score had an AUC of 0.80, 0.78, 0.82 (P=0.001, P=0.001, and P<0.001), respectively. Combining 24-h lactate level with pSOFA demonstrated superior performance (AUC=0.88).
Both 24-h lactate level and pSOAF are useful for prediction of mortality. Incorporating the 24-h lactate level into the pSOFA Score achieved superior prognostic utility.</description><subject>Adolescent</subject><subject>Biomarkers - blood</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Clinical Decision Rules</subject><subject>Critical Illness - mortality</subject><subject>Critically ill children</subject><subject>Female</subject><subject>Humans</subject><subject>Infant</subject><subject>Lactate</subject><subject>Lactic Acid - blood</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Mortality</subject><subject>Multiple Organ Failure - blood</subject><subject>Multiple Organ Failure - diagnosis</subject><subject>Multiple Organ Failure - mortality</subject><subject>Organ Dysfunction Scores</subject><subject>Pediatric</subject><subject>Pilot Projects</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Sequential Organ Failure Assessment Score</subject><issn>0929-693X</issn><issn>1769-664X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UdtqFEEQbUQxm9U_EOlHX3as6Z6diw_CEhIjBBKIQt6ampoa00vPxe6ewP6Rn2mvm7z6VLdzTlF1hPiQQ5ZDXn7eZ-hp5i5ToCADnQEUr8Qqr8pmU5bFw2uxgkalvNEPZ-I8hD0A1FDrt-JMK1XV27pZiT93DsOA0iFFjCwJR2mH2U9PLOMjSyRaPNJBTv2_-o47i9Fbkvf8e-ExWnTy1v9KtCu0bvEsdyFwCEOayXuaUqOfvJx9IlK003hUGiYf0dl4kHaU5G20hM6lyjlJj9Z1nscvcidn66YoQ1y6wzvxpkcX-P1zXIufV5c_Lq43N7ffvl_sbjakSxU3ZQe01X2nUQFusa0QC6qorEHpnCAHLIqybRlpm3PeN6ptVdXUUFFdQ9ORXotPJ930g3RgiGawgdg5HHlaglG6bhQ0OumtRXGCkp9C8Nyb2dsB_cHkYI4emb05eWSOHhnQJnmUaB-fNyztkGYvpBdTEuDrCcDpzifL3gSyPFL6oGeKppvs_zf8BZIMqDI</recordid><startdate>202005</startdate><enddate>202005</enddate><creator>El-Mekkawy, M.S.</creator><creator>Ellahony, D.M.</creator><creator>Khalifa, K.A.E.</creator><creator>Abd Elsattar, E.S.</creator><general>Elsevier Masson SAS</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202005</creationdate><title>Plasma lactate can improve the accuracy of the Pediatric Sequential Organ Failure Assessment Score for prediction of mortality in critically ill children: A pilot study</title><author>El-Mekkawy, M.S. ; Ellahony, D.M. ; Khalifa, K.A.E. ; Abd Elsattar, E.S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c362t-6d0c53fd3a20a5ab7aa4c7c680231c010a446bbeac51e1f92bb279807c8809dc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adolescent</topic><topic>Biomarkers - blood</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Clinical Decision Rules</topic><topic>Critical Illness - mortality</topic><topic>Critically ill children</topic><topic>Female</topic><topic>Humans</topic><topic>Infant</topic><topic>Lactate</topic><topic>Lactic Acid - blood</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Mortality</topic><topic>Multiple Organ Failure - blood</topic><topic>Multiple Organ Failure - diagnosis</topic><topic>Multiple Organ Failure - mortality</topic><topic>Organ Dysfunction Scores</topic><topic>Pediatric</topic><topic>Pilot Projects</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Sequential Organ Failure Assessment Score</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>El-Mekkawy, M.S.</creatorcontrib><creatorcontrib>Ellahony, D.M.</creatorcontrib><creatorcontrib>Khalifa, K.A.E.</creatorcontrib><creatorcontrib>Abd Elsattar, E.S.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Archives de pédiatrie : organe officiel de la Société française de pédiatrie</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>El-Mekkawy, M.S.</au><au>Ellahony, D.M.</au><au>Khalifa, K.A.E.</au><au>Abd Elsattar, E.S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Plasma lactate can improve the accuracy of the Pediatric Sequential Organ Failure Assessment Score for prediction of mortality in critically ill children: A pilot study</atitle><jtitle>Archives de pédiatrie : organe officiel de la Société française de pédiatrie</jtitle><addtitle>Arch Pediatr</addtitle><date>2020-05</date><risdate>2020</risdate><volume>27</volume><issue>4</issue><spage>206</spage><epage>211</epage><pages>206-211</pages><issn>0929-693X</issn><eissn>1769-664X</eissn><abstract>Plasma lactate has been used to predict the prognosis of critically ill children, but mortality risk scores appear to be more appealing, particularly in resource-limited countries.
To assess the prognostic utility of lactate compared with the pediatric Sequential Organ Failure Assessment (pSOFA) score among the general pediatric intensive care unit (PICU) population.
This was a prospective observational study including 78 children admitted to a tertiary-level PICU. Plasma lactate was measured upon admission and repeated 24h later. pSOFA score, Pediatric Risk of Mortality, and Pediatric Index of Mortality-2 (PIM2) were calculated. The primary outcome was 30-day mortality.
In total, 47.4% of patients had hyperlactatemia at admission. Among these, 20.5% had persistent hyperlactatemia. No significant difference in admission lactate level was found between survivors and nonsurvivors. The 24-h, peak, and average lactate levels were higher among nonsurvivors (P=0.005, 0.035, and 0.019, respectively). The 24-h lactate level and pSOFA score were independent predictors of mortality (adjusted odds ratio and 95% confidence interval=1.12 [1.02–1.23] and 1.80 [1.23–2.64], respectively]. The 24-h lactate level showed positive correlations with pSOFA, PRISM, and PIM2 (Spearman correlation coefficient=0.31, 0.23, 0.43; P=0.006, P=0.047, P<0.001, respectively). The 24-h lactate level had an area under the receiver operating characteristic curve (AUC) of 0.77 (P=0.013) for mortality prediction, while admission, peak, and average lactate level had an AUC of 0.69, 0.69, 0.71 (P=0.086, P=0.035, P=0.019), respectively. PIM2, PRISM, and pSOFA score had an AUC of 0.80, 0.78, 0.82 (P=0.001, P=0.001, and P<0.001), respectively. Combining 24-h lactate level with pSOFA demonstrated superior performance (AUC=0.88).
Both 24-h lactate level and pSOAF are useful for prediction of mortality. Incorporating the 24-h lactate level into the pSOFA Score achieved superior prognostic utility.</abstract><cop>France</cop><pub>Elsevier Masson SAS</pub><pmid>32278589</pmid><doi>10.1016/j.arcped.2020.03.004</doi><tpages>6</tpages></addata></record> |
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| identifier | ISSN: 0929-693X |
| ispartof | Archives de pédiatrie : organe officiel de la Société française de pédiatrie, 2020-05, Vol.27 (4), p.206-211 |
| issn | 0929-693X 1769-664X |
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| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Adolescent Biomarkers - blood Child Child, Preschool Clinical Decision Rules Critical Illness - mortality Critically ill children Female Humans Infant Lactate Lactic Acid - blood Logistic Models Male Mortality Multiple Organ Failure - blood Multiple Organ Failure - diagnosis Multiple Organ Failure - mortality Organ Dysfunction Scores Pediatric Pilot Projects Prognosis Prospective Studies Sequential Organ Failure Assessment Score |
| title | Plasma lactate can improve the accuracy of the Pediatric Sequential Organ Failure Assessment Score for prediction of mortality in critically ill children: A pilot study |
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