International Journal of Pediatrics

Current Issue

By Issue

By Author

By Subject

Author Index

Keyword Index

About Journal

Aims and Scope

Editorial Board

Publication Ethics

Indexing and Abstracting

Related Links

FAQ

Peer Review Process

News

The Association between Serum Lactate Level and Hospital Outcome in Children with Multi-Trauma

Document Type : original article

Authors

1 MD, Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

2 MD, Emergency Research Team, Tabriz University of Medical Sciences, Tabriz, Iran.

3 MD, Emergency Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.

4 Student, Islamic Azad University of Tabriz, Tabriz, Iran.

5 Assistant professor, MD-PhD of Medical Genetics, Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

Abstract

Background: Trauma is an important cause of disability and death in young people.  This study aimed to investigate the association between serum lactate level and in-hospital mortality in multi-traumatic children.
Method: In this cross-sectional study, all children with multi-trauma admitted to the emergency department in Shohada and Imam Reza hospitals of Tabriz/Iran were evaluated from 2018 to 2020. At the time of admission to the emergency department, serum lactate, PRISM (Pediatric risk of mortality) score, and other findings as well as outcome were checked and correlated with the outcomes for all patients. Patients were classified into two groups (based on outcome) and six groups (based on lactate levels) to evaluate associations between results. The Chi-square test, independent samples t-test, ANOVA, and multivariate logistic regression test were performed in SPSS.22. P-value<0.05 and OR with 95% confidence interval were considered statistically significant.
Result: Out of 110 admitted children, 10 (9%) died in hospital. Mean lactate level was 3.2 mmol/l and 85 patients (77.2%) had lactate level>2 mmol/l (millimoles). The initial blood lactate level was directly correlated with mortality.  This relationship was confirmed even after adjusting for variables such as the PRISM score (OR = 1.27; 95% CI, 1.19-1.35; P <0.001). Multiple regression study showed that a high lactate level (OR =1.17; 95% CI, 1.07-1.29; P=0.001), high PRISM score (OR = 1.15; 95% CI, 1.11-1.20; P<0.001), and low albumin level (OR =0.92; 95% CI, 0.88-0.96; P<0.001) were independent risk factors for mortality.
Conclusion: High blood lactate level was an independent factor in the increase of mortality rate in the emergency department.

Keywords

References
  1. Zamani M, Esmailian M, Mirazimi MS, Ebrahimian M, Golshani K. Cause and final outcome of trauma in patients referred to the emergency department: a cross sectional study. Iranian journal of emergency medicine. 2014; 1(1):22-7.
  2. Vos T, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. 2017; 390(10100):1211-59.
  3. Nordström A, Nordström P. Traumatic brain injury and the risk of dementia diagnosis: A nationwide cohort study. PLoS medicine. 2018; 15(1):e1002496.
  4. Vasterling JJ, Jacob SN, Rasmusson A. Traumatic brain injury and posttraumatic stress disorder: conceptual, diagnostic, and therapeutic considerations in the context of co-occurrence. The Journal of neuropsychiatry and clinical neurosciences. 2018; 30(2):91-100.
  5. Crewdson K, Rehn M, Lockey D. Airway management in pre-hospital critical care: a review of the evidence for a ‘top five research priority. Scandinavian journal of trauma, resuscitation and emergency medicine. 2018; 26(1):1-6.
  6. Fu Y-q, Bai K, Liu C-j. The impact of admission serum lactate on children with moderate to severe traumatic brain injury. PLoS One. 2019; 14(9):e0222591.
  7. D’Amours SK, Deane SA, Malka VB. 48 Principles of trauma management. Textbook of Surgery. 2020:431.
  8. Chandrashekar C, Prabhakar M, Santhoshkumar M, Harish R. Blood lactate as a predictor of mortality in critically ill children. Sri Lanka Journal of Child Health. 2018; 47(1):40-3.
  9. Dash HH, Chavali S. Management of traumatic brain injury patients. Korean journal of anesthesiology. 2018; 71(1):12.
  10. Khormi YH, Gosadi I, Campbell S, Senthilselvan A, O'kelly C, Zygun D. Adherence to brain trauma foundation guidelines for management of traumatic brain injury patients and its effect on outcomes: systematic review. Journal of Neurotrauma. 2018; 35(13):1407-18.
  11. Chang ET, Certal V, Song SA, Zaghi S, Carrasco-Llatas M, Torre C, Capasso R, Camacho M. Dexmedetomidine versus propofol during drug-induced sleep endoscopy and sedation: a systematic review. Sleep and Breathing. 2017; 21(3):727-35.
  12. Johnson MC, Alarhayem A, Convertino V, Carter III R, Chung K, Stewart R, Myers J, Dent D, Liao L, Cestero R, Nicholson S, Muir M, Schwaca M, Wampler D, DeRosa M, Eastridge BJ. Comparison of compensatory reserve and arterial lactate as markers of shock and resuscitation. Journal of Trauma and Acute Care Surgery. 2017; 83(4):603-8.
  13. Kubiak G, Tomasik A, Bartus K, Olszanecki R, Ceranowicz P. Lactate in cardiogenic shock-current understanding and clinical implications. J Physiol Pharmacol. 2018; 69(01):15-21.
  14. Gao F, Huang X-l, Cai M-X, Lin M-t, Wang B-f, Wu W, Huang ZM. Prognostic value of serum lactate kinetics in critically ill patients with cirrhosis and acute-on-chronic liver failure: a multicenter study. Aging (Albany NY). 2019; 11(13):4446.
  15. Baron BJ, Nguyen A, Stefanov D, Shetty A, Zehtabchi S. Clinical value of triage lactate in risk stratifying trauma patients using interval likelihood ratios. The American journal of emergency medicine. 2018; 36(5):784-8.
  16. Galvagno Jr SM, Massey M, Bouzat P, Vesselinov R, Levy MJ, Millin MG, Stein DM, Scalea TM, Hirshon JM. Correlation between the revised trauma score and injury severity score: implications for prehospital trauma triage. Prehospital emergency care. 2019; 23(2):263-70.
  17. Morteza J-B, Mandana R, Amir V, Leila V. Genetic pattern of cystic fibrosis patients in Azeri Turkish population. Russian Open Medical Journal. 2017; 6(1).
  18. Raffey M, Jabarpoor-Bonyadi M, Vahedi L. Genotype-Phenotype Correlation for Cystic Fibrosis According to the Registry Center of Cystic Fibrosis. Crescent Journal of Medical and Biological Sciences. 7(1).
  19. Morris KP, McShane P, Stickley J, Parslow RC. The relationship between blood lactate concentration, the Pediatric Index of Mortality 2 (PIM2) and mortality in pediatric intensive care. Intensive care medicine. 2012; 38(12):2042-6.
  20. Umebachi R, Taira T, Wakai S, Aoki H, Otsuka H, Nakagawa Y, Inokuchi S. Measurement of blood lactate, D-dimer, and activated prothrombin time improves prediction of in-hospital mortality in adults blunt trauma. The American journal of emergency medicine. 2018; 36(3):370-5.
  21. Bernhard M, Döll S, Kramer A, Weidhase L, Hartwig T, Petros S, Gries A. Elevated admission lactate levels in the emergency department are associated with increased 30-day mortality in non-trauma critically ill patients. Scandinavian journal of trauma, resuscitation and emergency medicine. 2020; 28(1):1-8.
  22. Safari E, Torabi M. Relationship between End-Tidal CO2 (ETCO2) and Lactate and their Role in Predicting Hospital Mortality in Critically Ill Trauma Patients; A Cohort Study. Bulletin of Emergency & Trauma. 2020; 8(2):83.
  23. Koliski A, Cat I, Giraldi DJ, Cat ML. Blood lactate concentration as prognostic marker in critically ill children. J Pediatr (Rio J). 2005; 81(4):287-92.
  24. Salvo F, Luppi F, Lucchesi DM, Canovi S, Franchini S, Polese A, Santi F, Trabucco L, Fasano T, Ferrari AM. Serum Copeptin levels in the emergency department predict major clinical outcomes in adult trauma patients. BMC emergency medicine. 2020; 20(1):1-10.
  25. Bai Z, Zhu X, Li M, Hua J, Li Y, Pan J, Wang J, Li Y. Effectiveness of predicting in-hospital mortality in critically ill children by assessing blood lactate levels at admission. BMC pediatrics. 2014; 14(1):83.
  26. Green JP, Berger T, Garg N, Horeczko T, Suarez A, Radeos MS, Hagar Y, Panacek EA. Hyperlactatemia affects the association of hyperglycemia with mortality in nondiabetic adults with sepsis. Academic Emergency Medicine. 2012; 19(11):1268-75.
  27. Gunnerson KJ, Saul M, He S, Kellum JA. Lactate versus non-lactate metabolic acidosis: a retrospective outcome evaluation of critically ill patients. Critical care. 2006; 10(1):R22.
  28. Kruse O, Grunnet N, Barfod C. Blood lactate as a predictor for in-hospital mortality in patients admitted acutely to hospital: a systematic review. Scandinavian journal of trauma, resuscitation and emergency medicine. 2011; 19(1):1-12.
  29. Charpie JR, Dekeon MK, Goldberg CS, Mosca RS, Bove EL, Kulik TJ. Serial blood lactate measurements predict early outcome after neonatal repair or palliation for complex congenital heart disease. The Journal of thoracic and cardiovascular surgery. 2000; 120(1):73-80.
  30. Fu YQ, Bai K, Liu CJ. The impact of admission serum lactate on children with moderate to severe traumatic brain injury. PloS one. 2019; 14(9):e0222591.
  31. Salas Ballestín A, de Carlos Vicente JC, Frontera Juan G, Sharluyan Petrosyan A, Reina Ferragut CM, González Calvar A, Clavero Rubio MDC, Fernández de la Ballina A. Prognostic Factors of Children Admitted to a Pediatric Intensive Care Unit After an Episode of Drowning. Pediatr Emerg Care. 2021 Apr 1; 37(4):e192-e195.
International Journal of Pediatrics
Volume 10, Issue 10
October 2022
Pages 16794-16802
Files
Share
How to cite
Statistics