الفهرس 
Epidemiology of childhood mortalityOnly 14 pages are availabe for public view
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Abstract
Clinical findings and laboratory test results on admission to the
intensive care unit (ICU) reflect the most recent pathophysiological
findings. The events in the hours that follow admission are often a
development of those events. Based on this information, the changes
in these parameters on admission as well as in the outcome of ICU
patients have been used to establish the risk of death, both in adults
and children, and blood lactate levels are one of the most commonly
used methods.
Blood lactate levels are used in several situations, such as
marker for tissue hypoperfusion in shocked patients, indicator of
adequate post-shock resuscitation, prognostic index after resuscitation,
prognostic factor in case of severe diseases, and as etiologic diagnosis.
Most cases of hyperlactatemia in critically ill patients are due to
inappropriate tissue oxygenation. This condition may result from
respiratory disorders with poor blood oxygenation or from circulatory
disorders that cause tissue hypoperfusion. As patients with tissue
hypoperfusion do not always show clinical signs, hyperlactatemia may
be the only marker for this disorder.
Our aim in the current research was to assess the prognostic
value of lactate among critically ill children.
This was a prospective study including 78 pediatric patients
admitted into PICU of Menoufia university Hospital. Their ages
ranged from one month to 18 years.
Full history was taken from patients including, personal history,
complaint, history of present illness, past history of diseases,
Summary
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operations or medication, family history, dietetic and vaccination
history.
Thorough clinical examination included: general and local
examination with emphasis on vital signs. Severity of illness in the
first 24 hours was assessed by using. PRISM, PIM2, and pediatric
SOFA score, laboratory investigations included: CBC, CRP, blood
glucose, serum electrolytes, blood gas analysis, Blood Culture.
Radiologic investigation was ordered when indicated. Plasma lactate
was measured within 2hours of PICU admission and 24hours later.
The primary outcome will be 30-day mortality. Secondary
outcomes include length of PICU stay and the need for mechanical
ventilation.
Non–survivors had asignificantly higher 24-hour, peak and
average lactate level compared with survivors. Non survivor group
also had asignificantly higher frequency of persistant hyperlactatemia
after 24-hours. Univariate and multivariate logistic regression analysis
showed that pSOFA and 24-hour lactate were independent predictors
of mortality.
Admission lactate was positively correlated with both PRISM
and pSOFA scores. 24-hr lactate was positively correlated with
PRISM, PIM2, and pSOFA score, pSOFA had the largest area under
the curve (ROC) for prediction of mortality followed PIM2, then
PRISM, then 24-hour lactate level. Admission lactate and lactate
clearance failed to predict mortality at a cut off 16.6 mg/dl or more.
24-hr lactate had a sensitivity of 77.8% and a specificity of
71.4% for prediction of mortality.