Handheld Point-of-Care Lactate Measurement at Admission Predicts Mortality in Ugandan Children Hospitalized with Pneumonia: A Prospective Cohort Study
Document Type
Article
Department
Paediatrics and Child Health (East Africa)
Abstract
Globally, pneumonia is the leading cause of death among children younger than 5 years old, with most deaths occurring in low-income countries. Rapid bedside tools to assist practitioners to accurately triage and risk-stratify these patients may improve clinical care and patient outcomes. We conducted a prospective cohort study of children with pneumonia admitted to two Ugandan hospitals to examine the predictive value of a single point-of-care lactate mea- surement using a commercially available handheld device, the Lactate Scout Analyzer. One hundred and fifty-five children were included, 90 (58%) male, with a median (interquartile range [IQR]) age of 11 (1.4–20) months. One hundred and twenty-five (81%) patients had chest indrawing, 133 (86%) were hypoxemic, and 75 (68%) had a chest x-ray abnormality. In-hospital mortality was 22/155 (14%). Median (IQR) admission lactate level was 2.4 (1.8–3.6) mmol/L among children who survived versus 7.2 (2.6–9.7) mmol/L among those who died (P < 0.001). Lactate was a better prognostic marker of mortality (area under receiver operator characteristic 0.76, 95% confidence interval: 0.69–0.87, P £ 0.001), than any single clinical sign or composite clinical risk score. Lactate level at admission of < 2.0, 2.0–4.0, and > 4.0 mmol/L accurately risk- stratified children, with 5-day mortality of 2%, 11% and 26%, respectively (P < 0.001). Slow lactate clearance also predicted subsequent mortality in children with repeated lactate measurements. Hand-held lactate measurement is a clinically informative and convenient tool in low-resource settings for triage and risk stratification of pediatric pneumonia.
Publication (Name of Journal)
The American Society of Tropical Medicine and Hygiene
DOI
10.4269/ajtmh.18-0344
Recommended Citation
Ma, C.,
Gunaratnam, L. C.,
Ericson, A.,
Conroy, A. L.,
Namasopo, S.,
Opoka, R.,
Hawkes, M. T.
(2019). Handheld Point-of-Care Lactate Measurement at Admission Predicts Mortality in Ugandan Children Hospitalized with Pneumonia: A Prospective Cohort Study. The American Society of Tropical Medicine and Hygiene, 100(1), 37-42.
Available at:
https://ecommons.aku.edu/eastafrica_fhs_mc_paediatr_child_health/420
Comments
This work was published before the author joined Aga Khan University.