Lactate Clearance as a Prognostic Marker of Mortality in Severely Ill Febrile Children in East Africa

El Aclaramiento de Lactato como Marcador Pronóstico de Mortalidad en Niños con Fiebre Grave en África Oriental

In African countries with limited resources, the main cause of death in children under 5 years old is infection, mainly related to pneumonia, diarrhea, and malaria. In these countries Health units usually have basic facilities, and children with severe infection usually present in a critically ill condition, with most deaths occurring within the first 24 h of admission. Immediate recognition and prompt appropriate resuscitation of those children at highest risk of death are decisive to improve survival. Hyperlactataemia predicts mortality in patients with sepsis and malaria, and lactate clearance during resuscitation has been shown to be a prognostic factor of survival in critically ill adults, but little data exist for African children living in malaria-endemic areas.

The main aim of the current study was to assess the prognostic value of lactate clearance at 8 hours on all-cause mortality at 72 hours in a large cohort of severely ill febrile children in a malaria-endemic area. Secondary aims were to confirm the association between hyperlactataemia and all-cause mortality at 72 hours, assess if this was modified depending on the type of severe febrile illness (malaria vs non-malaria), and to determine the cut-off lactate level on admission that best predicts mortality in these children.

This study was carried out between January 2009 and January 2011 at six clinical centres, in three east African countries.

At admission, lactate, haemoglobin, and glucose measurements were taken, together with an HIV antibody test, malaria blood film, and a rapid diagnostic test for malaria. Lactate and haemoglobin measurements were repeated at 8 and 24 hours. Lactate was measured using a Lactate Pro hand-held analyser.

In conclusion, severe hyperlactataemia, defined as a venous lactate level ≥ 5 mmol/L on hospital admission, is a strong risk factor for death within the first 72 hours in children with severe febrile illnesses in east Africa, independently of the underlying diagnosis. Failure to clear lactate (relative lactate clearance ≤ 10%) within 8 hours is also strongly prognostic of death.

This study was completed by Aramburo et al. and published in 2018 in BMC Medicine (Aramburo et al. BMC Medicine (2018) 16:37).

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Lactate clearance as a prognostic marker of mortality in severely ill febrile children in East Africa