Early lactate levels and 30-day mortality in pediatric sepsis _ critical care medicine _ jama pediatrics _ the jama network

Importance Improving emergency care of pediatric sepsis is a public health priority, but optimal early diagnostic approaches are unclear. Database kernel Measurement of lactate levels is associated with improved outcomes in adult septic shock, but pediatric guidelines do not endorse its use, in part because the association between early lactate levels and mortality is unknown in pediatric sepsis.

Design, Setting, and Participants This observational cohort study of a clinical registry of pediatric patients with suspected sepsis in the emergency department of a tertiary children’s hospital from April 1, 2012, to December 31, 2015, tested the hypothesis that a serum lactate level of greater than 36 mg/dL is associated with increased mortality compared with a serum lactate level of 36 mg/dL or less.

Raid 5 data recovery software Consecutive patients with sepsis were identified and included in the registry following consensus guidelines for clinical recognition (infection and decreased mental status or perfusion). Data recovery pro Among 2520 registry visits, 1221 were excluded for transfer from another medical center, no measurement of lactate levels, and patients younger than 61 days or 18 years or older, leaving 1299 visits available for analysis. Data recovery tools mac Lactate testing is prepopulated in the institutional sepsis order set but may be canceled at clinical discretion.

Main Outcomes and Measures Thirty-day in-hospital mortality was the primary outcome. Z wave database Odds ratios were calculated using logistic regression to account for potential confounders.

Results Of the 1299 patients included in the analysis (753 boys [58.0%] and 546 girls [42.0%]; mean [SD] age, 7.3 [5.3] years), 899 (69.2%) had chronic medical conditions and 367 (28.3%) had acute organ dysfunction. Database orm Thirty-day mortality occurred in 5 of 103 patients (4.8%) with lactate levels greater than 36 mg/dL and 20 of 1196 patients (1.7%) with lactate levels of 36 mg/dL or less. Database workbench Initial lactate levels of greater than 36 mg/dL were significantly associated with 30-day mortality in unadjusted (odds ratio, 3.00; 95% CI, 1.10-8.17) and adjusted (odds ratio, 3.26; 95% CI, 1.16- 9.16) analyses. Database best practices The sensitivity of lactate levels greater than 36 mg/dL for 30-day mortality was 20.0% (95% CI, 8.9%-39.1%), and specificity was 92.3% (90.7%-93.7%).

Conclusions and Relevance In children treated for sepsis in the emergency department, lactate levels greater than 36 mg/dL were associated with mortality but had a low sensitivity. Database schema Measurement of lactate levels may have utility in early risk stratification of pediatric sepsis.