Handheld Point-of-Care Lactate Measurement at Admission Predicts Mortality in Ugandan Children Hospitalized with Pneumonia: A Prospective Cohort Study

Cary Ma University of Alberta, Edmonton, Canada;

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Lourdes Cynthia Gunaratnam University of Alberta, Edmonton, Canada;

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Austin Ericson University of Alberta, Edmonton, Canada;

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Andrea L. Conroy Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis, Indiana;

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Sophie Namasopo Department of Paediatrics, Jinja Regional Referral Hospital, Jinja, Uganda;

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Robert O. Opoka Department of Paediatrics and Child Health, Mulago Hospital, Makerere University, Kampala, Uganda;

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Michael T. Hawkes Department of Pediatrics, University of Alberta, Edmonton, Canada;
Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Canada;
School of Public Health, University of Alberta, Edmonton, Canada

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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.

Author Notes

Address correspondence to Michael T. Hawkes, Department of Pediatrics, University of Alberta, 3-588D Edmonton Clinic Health Academy, 11405 87 Ave. NW, Edmonton T6G 1C9, Canada. E-mail: mthawkes@ualberta.ca

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.

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