Outcome of early hyperlactataemia in critically ill children

Objective

To examine the relationships between hyperlactataemia, acidosis, organ failure, and mortality in children admitted to intensive care.

Design

Prospective observational study. Children with lactate levels >2 mmol/l within 24 h of admission were enrolled. Post-operative patients and those with inherited metabolic disease were excluded. The Paediatric Risk of Mortality (PRISM) score, Multiorgan System Failure (MOSF) score, length of ICU stay, and outcome were recorded. Data were collected for pH, base deficit (BE), and lactate (mmol/l) on admission at 12 and 24 h. Data are reported as median (range). Fifty children aged 20.3 months (0.1–191) were enrolled. Data were analysed by the Mann-Whitney, Fisher's Exact, Kruskal-Wallis tests, and the Chi-squared test for trend.

Results

Median PRISM score was 19 (4–49), median MOSF score 2 (0–5), and observed mortality 32/50 (64%). Median duration of ICU stay was 6 days (2–32) in survivors, and median time until death 3 days (0–13) in nonsurvivors. Eleven nonsurvivors (34%) died within 24 h.

Admission lactate did not increase with increasing MOSF score (P = 0.5). However mortality increased with increasing MOSF score (P = 0.005).

Conclusion

Early hyperlactataemia is associated with a high mortality in critically ill children. Organ failure and peak lactate levels may distinguish nonsurvivors in this group.

Table 1