Serum lactate as a predictor of mortality after paediatric cardiac surgery. Issue 3 (1st September 1997)

• Record Type: Journal Article
• Authors: Hatherill, M; Sajjanhar, T; Tibby, S M; Champion, M P; Anderson, D; Marsh, M J; Murdoch, I A
• Is Part Of: Archives of disease in childhood. Volume 77:Issue 3(1997)
• Page Start: 235
• Page End: 238
• Publication Date: 1997-09-01
• Subjects: cardiac surgery -- lactate -- mortality; Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/adc.77.3.235
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : OBJECTIVE: To assess the value of sequential lactate measurement in predicting postoperative mortality after surgery for complex congenital heart disease in children. DESIGN: Prospective observational study. SETTING: Sixteen bedded paediatric intensive care unit (PICU). SUBJECTS: Ninety nine children ( 90 survivors, nine non-survivors). MEASUREMENTS: Serum lactate and base deficit were measured on admission and every six hours thereafter. Data were analysed by Mann-Whitney and Fisher's exact tests. RESULTS: There was considerable overlap in initial lactate values between the survivor and non-survivor groups. Initial lactate was significantly raised in non-survivors (median 8.7, range 1.9–17.6 mmol/l) compared with survivors (median 2.4, range 0.6–13.6 mmol/l) (p = 0.0002). Twenty one patients (21.1%) with initial lactate concentrations greater than 4.5 mmol/l survived to PICU discharge. Using receiver operating characteristic analysis an initial lactate of 6 mmol/l had the optimum predictive value for mortality. Initial postoperative serum lactate >6 mmol/l predicted mortality with sensitivity 78%, specificity 83%, and positive predictive value of only 32%. CONCLUSION: Initial lactate concentrations have poor positive predictive value for mortality. The routine measurement of lactate for this purpose cannot be justified in clinical practice.