Wang H et al. 2014. Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 384: 957–979.
Conroy AL, Lafferty EI, Lovegrove FE, Krudsood S, Tangpukdee N, Liles WC, Kain KC, 2009. Whole blood angiopoietin-1 and -2 levels discriminate cerebral and severe (non-cerebral) malaria from uncomplicated malaria. Malar J 8: 295.
Leung DT, Chisti MJ, Pavia AT, 2016. Prevention and control of childhood pneumonia and diarrhea. Pediatr Clin North Am 63: 67–79.
Naydenova E, Tsanas A, Howie S, Casals-Pascual C, De Vos M, 2016. The power of data mining in diagnosis of childhood pneumonia. J R Soc Interface 13: 20160266.
Huang H et al. 2014. Discovery and validation of biomarkers to guide clinical management of pneumonia in African children. Clin Infect Dis 58: 1707–1715.
Scott JA et al. Pneumonia Methods Working Group, 2012. The definition of pneumonia, the assessment of severity, and clinical standardization in the pneumonia etiology research for child health study. Clin Infect Dis 54(Suppl 2): S109–S116.
WHO/UNICEF Joint Statement, Integrated Community Case Management (iCCM), 2012. Integrated Community Case Management. An Equity-Focused Strategy to Improve Access to Essential Treatment Services for Children. Available at: http://www.who.int/maternal_child_adolescent/documents/statement_child_services_access_whounicef.pdf. Accessed April 21, 2016.
World Health Organization (WHO), 2014. Revised WHO Classification and Treatment of Childhood Pneumonia at Health Facilities. Available at: www.who.int. Accessed April 21, 2016.
Andersen LW, Mackenhauer J, Roberts JC, Berg KM, Cocchi MN, Donnino MW, 2013. Etiology and therapeutic approach to elevated lactate levels. Mayo Clin Proc 88: 1127–1140.
Chen YX, Li CS, 2015. Lactate on emergency department arrival as a predictor of mortality and site-of-care in pneumonia patients: a cohort study. Thorax 70: 404–410.
Shapiro NI, Howell MD, Talmor D, Nathanson LA, Lisbon A, Wolfe RE, Weiss JW, 2005. Serum lactate as a predictor of mortality in emergency department patients with infection. Ann Emerg Med 45: 524–528.
Mikkelsen ME, Miltiades AN, Gaieski DF, Goyal M, Fuchs BD, Shah CV, Bellamy SL, Christie JD, 2009. Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock. Crit Care Med 37: 1670–1677.
Juneja D, Singh O, Dang R, 2011. Admission hyperlactatemia: causes, incidence, and impact on outcome of patients admitted in a general medical intensive care unit. J Crit Care 26: 316–320.
Khosravani H, Shahpori R, Stelfox HT, Kirkpatrick AW, Laupland KB, 2009. Occurrence and adverse effect on outcome of hyperlactatemia in the critically ill. Crit Care 13: R90.
Frenzen FS, Kutschan U, Meiswinkel N, Schulte-Hubbert B, Ewig S, Kolditz M, 2017. Admission lactate predicts poor prognosis independently of the CRB/CURB-65 scores in community-acquired pneumonia. Clin Microbiol Infect 24: 306.e1–306.e6.
Demirel B, 2017. Lactate levels and pneumonia severity index are good predictors of in-hospital mortality in pneumonia. Clin Respir J 12: 991–995.
Gwak MH, Jo S, Jeong T, Lee JB, Jin YH, Yoon J, Park B, 2015. Initial serum lactate level is associated with inpatient mortality in patients with community-acquired pneumonia. Am J Emerg Med 33: 685–690.
Hawkes M, Conroy AL, Opoka RO, Namasopo S, Liles WC, John CC, Kain KC, 2014. Performance of point-of-care diagnostics for glucose, lactate, and hemoglobin in the management of severe malaria in a resource-constrained hospital in Uganda. Am J Trop Med Hyg 90: 605–608.
Ramakrishna B, Graham SM, Phiri A, Mankhambo L, Duke T, 2012. Lactate as a predictor of mortality in Malawian children with WHO-defined pneumonia. Arch Dis Child 97: 336–342.
Mulholland K, 2007. Childhood pneumonia mortality—a permanent global emergency. Lancet 370: 285–289.
Bonafide CP, Brady PW, Keren R, Conway PH, Marsolo K, Daymont C, 2013. Development of heart and respiratory rate percentile curves for hospitalized children. Pediatrics 131: e1150–e1157.
George EC et al. 2015. Predicting mortality in sick African children: the FEAST Paediatric Emergency Triage (PET) score. BMC Med 13: 174.
Parshuram, 2009. Development and initial validation of the bedside paediatric early warning system score. Crit Care 13: R135.
Berkley JA, Ross A, Mwangi I, Osier FH, Mohammed M, Shebbe M, Lowe BS, Marsh K, Newton CR, 2003. Prognostic indicators of early and late death in children admitted to district hospital in Kenya: cohort study. BMJ 326: 361.
Helbok R et al. 2009. The Lambarene Organ Dysfunction Score (LODS) is a simple clinical predictor of fatal malaria in African children. J Infect Dis 200: 1834–1841.
Bhal S, Tygai V, Kumar N, Sreenivas V, Puliyel JM, 2006. Signs of inflammation in children that can kill (SICK score): preliminary prospective validation of a new non-invasive measure of severity-of-illness. J Postgrad Med 52: 102–105.
Hooli S, Colbourn T, Lufesi N, Costello A, Nambiar B, Thammasitboon S, Makwenda C, Mwansambo C, McCollum ED, King C, 2016. Predicting hospitalised paediatric pneumonia mortality risk: an external validation of RISC and mRISC, and local tool development (RISC-Malawi) from Malawi. PLoS One 11: e0168126.
Aramburo A et al. 2018. Lactate clearance as a prognostic marker of mortality in severely ill febrile children in east Africa. BMC Med 16: 37.
Mukanga D, Babirye R, Peterson S, Pariyo GW, Ojiambo G, Tibenderana JK, Nsubuga P, Kallander K, 2011. Can lay community health workers be trained to use diagnostics to distinguish and treat malaria and pneumonia in children? Lessons from rural Uganda. Trop Med Int Health 16: 1234–1242.
Bates D, Maechler M, Bolker B, Walker S, 2015. Fitting linear mixed-effects models using lme4. J Stat Software 67: 1–48.
Berkley JA, Ross A, Mwangi I, Osier FH, Mohammed M, Shebbe M, Lowe BS, Marsh K, Newton CR, 2003. Prognostic indicators of early and late death in children admitted to district hospital in Kenya: cohort study. BMJ 326: 361.
Fleming S, Thompson M, Stevens R, Heneghan C, Plüddemann A, Maconochie I, Tarassenko L, Mant D, 2011. Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies. Lancet 377: 1011–1018.
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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 measurement 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.
Financial support: This study was supported by Grand Challenges Canada.
Authors’ addresses: Cary Ma, L. Cynthia Gunaratnam, Austin Ericson, and Michael T. Hawkes, Department of Pediatrics, University of Alberta, 3-588D Edmonton Clinic Health Academy, Edmonton, Canada, E-mails: cary2@ualberta.ca, gunaratn@ualberta.ca, ericsona16@gmail.com, and mthawkes@ualberta.ca. Andrea L. Conroy, Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis, IN, E-mail: andrea.conroy@gmail.com. Sophie Namasopo, Kabale Regional Referral Hospital, Kabale, Uganda, E-mail: somnamasopo@yahoo.com. Robert O. Opoka, Department of Pediatrics and Child Health, Mulago Hospital, Makerere University, Kampala, Uganda, E-mail: opokabob@yahoo.com.
Wang H et al. 2014. Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 384: 957–979.
Conroy AL, Lafferty EI, Lovegrove FE, Krudsood S, Tangpukdee N, Liles WC, Kain KC, 2009. Whole blood angiopoietin-1 and -2 levels discriminate cerebral and severe (non-cerebral) malaria from uncomplicated malaria. Malar J 8: 295.
Leung DT, Chisti MJ, Pavia AT, 2016. Prevention and control of childhood pneumonia and diarrhea. Pediatr Clin North Am 63: 67–79.
Naydenova E, Tsanas A, Howie S, Casals-Pascual C, De Vos M, 2016. The power of data mining in diagnosis of childhood pneumonia. J R Soc Interface 13: 20160266.
Huang H et al. 2014. Discovery and validation of biomarkers to guide clinical management of pneumonia in African children. Clin Infect Dis 58: 1707–1715.
Scott JA et al. Pneumonia Methods Working Group, 2012. The definition of pneumonia, the assessment of severity, and clinical standardization in the pneumonia etiology research for child health study. Clin Infect Dis 54(Suppl 2): S109–S116.
WHO/UNICEF Joint Statement, Integrated Community Case Management (iCCM), 2012. Integrated Community Case Management. An Equity-Focused Strategy to Improve Access to Essential Treatment Services for Children. Available at: http://www.who.int/maternal_child_adolescent/documents/statement_child_services_access_whounicef.pdf. Accessed April 21, 2016.
World Health Organization (WHO), 2014. Revised WHO Classification and Treatment of Childhood Pneumonia at Health Facilities. Available at: www.who.int. Accessed April 21, 2016.
Andersen LW, Mackenhauer J, Roberts JC, Berg KM, Cocchi MN, Donnino MW, 2013. Etiology and therapeutic approach to elevated lactate levels. Mayo Clin Proc 88: 1127–1140.
Chen YX, Li CS, 2015. Lactate on emergency department arrival as a predictor of mortality and site-of-care in pneumonia patients: a cohort study. Thorax 70: 404–410.
Shapiro NI, Howell MD, Talmor D, Nathanson LA, Lisbon A, Wolfe RE, Weiss JW, 2005. Serum lactate as a predictor of mortality in emergency department patients with infection. Ann Emerg Med 45: 524–528.
Mikkelsen ME, Miltiades AN, Gaieski DF, Goyal M, Fuchs BD, Shah CV, Bellamy SL, Christie JD, 2009. Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock. Crit Care Med 37: 1670–1677.
Juneja D, Singh O, Dang R, 2011. Admission hyperlactatemia: causes, incidence, and impact on outcome of patients admitted in a general medical intensive care unit. J Crit Care 26: 316–320.
Khosravani H, Shahpori R, Stelfox HT, Kirkpatrick AW, Laupland KB, 2009. Occurrence and adverse effect on outcome of hyperlactatemia in the critically ill. Crit Care 13: R90.
Frenzen FS, Kutschan U, Meiswinkel N, Schulte-Hubbert B, Ewig S, Kolditz M, 2017. Admission lactate predicts poor prognosis independently of the CRB/CURB-65 scores in community-acquired pneumonia. Clin Microbiol Infect 24: 306.e1–306.e6.
Demirel B, 2017. Lactate levels and pneumonia severity index are good predictors of in-hospital mortality in pneumonia. Clin Respir J 12: 991–995.
Gwak MH, Jo S, Jeong T, Lee JB, Jin YH, Yoon J, Park B, 2015. Initial serum lactate level is associated with inpatient mortality in patients with community-acquired pneumonia. Am J Emerg Med 33: 685–690.
Hawkes M, Conroy AL, Opoka RO, Namasopo S, Liles WC, John CC, Kain KC, 2014. Performance of point-of-care diagnostics for glucose, lactate, and hemoglobin in the management of severe malaria in a resource-constrained hospital in Uganda. Am J Trop Med Hyg 90: 605–608.
Ramakrishna B, Graham SM, Phiri A, Mankhambo L, Duke T, 2012. Lactate as a predictor of mortality in Malawian children with WHO-defined pneumonia. Arch Dis Child 97: 336–342.
Mulholland K, 2007. Childhood pneumonia mortality—a permanent global emergency. Lancet 370: 285–289.
Bonafide CP, Brady PW, Keren R, Conway PH, Marsolo K, Daymont C, 2013. Development of heart and respiratory rate percentile curves for hospitalized children. Pediatrics 131: e1150–e1157.
George EC et al. 2015. Predicting mortality in sick African children: the FEAST Paediatric Emergency Triage (PET) score. BMC Med 13: 174.
Parshuram, 2009. Development and initial validation of the bedside paediatric early warning system score. Crit Care 13: R135.
Berkley JA, Ross A, Mwangi I, Osier FH, Mohammed M, Shebbe M, Lowe BS, Marsh K, Newton CR, 2003. Prognostic indicators of early and late death in children admitted to district hospital in Kenya: cohort study. BMJ 326: 361.
Helbok R et al. 2009. The Lambarene Organ Dysfunction Score (LODS) is a simple clinical predictor of fatal malaria in African children. J Infect Dis 200: 1834–1841.
Bhal S, Tygai V, Kumar N, Sreenivas V, Puliyel JM, 2006. Signs of inflammation in children that can kill (SICK score): preliminary prospective validation of a new non-invasive measure of severity-of-illness. J Postgrad Med 52: 102–105.
Hooli S, Colbourn T, Lufesi N, Costello A, Nambiar B, Thammasitboon S, Makwenda C, Mwansambo C, McCollum ED, King C, 2016. Predicting hospitalised paediatric pneumonia mortality risk: an external validation of RISC and mRISC, and local tool development (RISC-Malawi) from Malawi. PLoS One 11: e0168126.
Aramburo A et al. 2018. Lactate clearance as a prognostic marker of mortality in severely ill febrile children in east Africa. BMC Med 16: 37.
Mukanga D, Babirye R, Peterson S, Pariyo GW, Ojiambo G, Tibenderana JK, Nsubuga P, Kallander K, 2011. Can lay community health workers be trained to use diagnostics to distinguish and treat malaria and pneumonia in children? Lessons from rural Uganda. Trop Med Int Health 16: 1234–1242.
Bates D, Maechler M, Bolker B, Walker S, 2015. Fitting linear mixed-effects models using lme4. J Stat Software 67: 1–48.
Berkley JA, Ross A, Mwangi I, Osier FH, Mohammed M, Shebbe M, Lowe BS, Marsh K, Newton CR, 2003. Prognostic indicators of early and late death in children admitted to district hospital in Kenya: cohort study. BMJ 326: 361.
Fleming S, Thompson M, Stevens R, Heneghan C, Plüddemann A, Maconochie I, Tarassenko L, Mant D, 2011. Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies. Lancet 377: 1011–1018.
Past two years | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 500 | 451 | 13 |
Full Text Views | 511 | 16 | 0 |
PDF Downloads | 219 | 16 | 0 |