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Abstract
An elevated concentration (>2.5 mmol/L) of lactic acid in blood has been demonstrated to be indicative of recent or ongoing anaerobic metabolism, generally as a consequence of insufficient oxygen delivery to meet organ demands Several recent studies in humans have demonstrated the value of lactate measurement for the prediction of adverse outcome, the role of lactate in the management of critically ill children is in alerting clinicians to a higher risk of mortality or adverse events, and it is a useful tool to monitor response to treatment. High blood lactate indicates severe physiological derangement associated with an increased risk of mortality in our study we aimed to establish whether the extent of early hyperlactatemia is predictor of mortality in critically ill children and study the relation between serum lactate and clinical scores as MODS and PRSM scores in prediction of mortality in PICU . the study was carried out at Pediatric Intensive Care Unit (PICU) Zagazig University Hospital in the period from December 2003 to December 2004.our study included 50 critically ill patients who were admitted in (PICU) and had blood lactate level within 6 hours after admission more than 2 mmol / L. 50 critically ill patients admitted in our PICU who had lactate level more than 2mmol/ l within 6 hours of admission were studied for outcome where 24 cases were male (48%) and 26 cases were female (52%) .
We founded that our selected patients with early hyperlactatemia showed high observed mortality 60% and high severity scoring systems and we founded insignificant correlation between the initial lactate level and mortality rate (p value =0.62) but persistent hyperlactatemia was associated with increase mortality (p value =0.001) . Also in our study we founded that PRISM score had significant correlation with mortality (p value= 0.001) and there were significant correlation between MODS and mortality p value =0.001 we founded that lactate at admission had sensitivity 53.3%,and specificity 60%, positive predictive value for death 66.7%,and negative predictive value for death 46.2%.
Lactate after 24 hour had sensitivity 86.7%,and specificity 80%,positive predictive value for death 86.7%, and negative predictive value for death 80%.
Prism score had sensitivity 82%,speceficty 85%.
MODS had sensitivity 60%,speceficty 90%.