Document Type
Article
Department
Paediatrics and Child Health (East Africa)
Abstract
Respiratory distress (RD) in pediatric malaria portends a grave prognosis. Lactic acidosis is a biomarker of severe disease. We investigated whether lactate, measured at admission using a handheld device among children hospitalized with malaria and RD, was predictive of subsequent mortality. We performed a pooled analysis of Ugandan children under five years of age hospitalized with malaria and RD from three past studies. In total, 1324 children with malaria and RD (median age 1.4 years, 46% female) from 21 health facilities were included. Median lactate level at admission was 4.6 mmol/L (IQR 2.6–8.5) and 586 patients (44%) had hyperlactatemia (lactate > 5 mmol/L). The mortality was 84/1324 (6.3%). In a mixed-effects Cox proportional hazard model adjusting for age, sex, clinical severity score (fixed effects), study, and site (random effects), hyperlactatemia was associated with a 3-fold increased hazard of death (aHR 3.0, 95%CI 1.8–5.3, p < 0.0001). Delayed capillary refill time (τ = 0.14, p < 0.0001), hypotension (τ = −0.10, p = 0.00049), anemia (τ = −0.25, p < 0.0001), low tissue oxygen delivery (τ = −0.19, p < 0.0001), high parasite density (τ = 0.10, p < 0.0001), and acute kidney injury (p = 0.00047) were associated with higher lactate levels. In children with malaria and RD, bedside lactate may be a useful triage tool, predictive of mortality.
Publication (Name of Journal)
Microorganisms
Recommended Citation
Mitran, C.,
Opoka, R.,
Conroy, A.,
Namasopo, S.,
Kain, K.,
Hawkes, M.
(2023). Pediatric Malaria with Respiratory Distress: Prognostic Significance of Point-of-Care Lactate. Microorganisms, 11(4), 1-20.
Available at:
https://ecommons.aku.edu/eastafrica_fhs_mc_paediatr_child_health/232
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Comments
This work was published before the author joined Aga Khan University.