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The relationship between blood lactate concentration, the Paediatric Index of Mortality 2 (PIM2) and mortality in paediatric intensive care

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Abstract

Introduction

Blood lactate concentration predicts mortality in neonates, infants, children and adults, with evidence that it has better predictive power than other markers of acid–base status such as absolute base excess or pH.

Objective

To investigate whether blood lactate concentration on admission predicts mortality in paediatric intensive care and if its addition can improve the performance of the Paediatric Index of Mortality 2 (PIM2) mortality prediction score.

Design and setting

Retrospective cohort study in one 20-bed UK paediatric intensive care unit (PICU) using data from the PICU clinical and blood gas analyser databases between 2006 and 2010. Only cases with a blood lactate concentration measured at the same time as the PIM2 variables were included. Logistic regression was used to assess if blood lactate concentration predicted mortality independently of PIM2, adjusting for potential confounders, and if it could replace absolute base excess in the PIM2 model.

Results

There were 155 deaths amongst 2,380 admissions (6.5 %). Admission lactate in non-survivors was higher than in survivors (mean [standard deviation, SD]) 6.6 [5.6] versus 3.0 [2.5] mmol/l, had a positive association with mortality [adjusted odds ratio (OR) for death per unit (mmol/l)] increase 1.11 [95 % confidence interval (CI) 1.06–1.16; p < 0.001] and significantly improved the model fit of PIM2 when it replaced absolute base excess (p < 0.001).

Conclusions

PICU admission blood lactate concentration predicts mortality independently of PIM2. Given the limitations of this study, a prospective multi-centre evaluation is required to establish whether it should be added to the PIM2 model with or without replacement of base excess.

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Acknowledgments

We would like to thank all the staff in the participating hospital who have collected data for PICANet. We are grateful to the UK Paediatric Intensive Care Society for continued support and to the members of the PICANet Steering Group and Clinical Advisory Group who are listed on our website: http://www.picanet.org.uk/participants.html. PICANet is funded by the National Clinical Audit and Patient Outcomes Programme via the Healthcare Quality Improvement Partnership (HQIP), Health Commission Wales Specialised Services, NHS Lothian/National Service Division NHS Scotland, the Royal Belfast Hospital for Sick Children, Our Lady’s Children’s Hospital, Crumlin, Dublin, Children’s University Hospital, Temple Street, Dublin and The Harley Street Clinic, London.

Conflicts of interest

There are no conflicts of interest affecting the work presented here.

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Authors and Affiliations

  1. Paediatric Intensive Care Unit, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK

    Kevin P. Morris & John Stickley

  2. Paediatric Epidemiology Group, Centre for Epidemiology and Biostatistics, Leeds Institute of Genetics, Health and Therapeutics (LIGHT), University of Leeds, 30 Hyde Terrace, Leeds, LS2 9JT, UK

    Phil McShane & Roger C. Parslow

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  1. Kevin P. Morris
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  2. Phil McShane
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Correspondence to Kevin P. Morris.

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Morris, K.P., McShane, P., Stickley, J. et al. The relationship between blood lactate concentration, the Paediatric Index of Mortality 2 (PIM2) and mortality in paediatric intensive care. Intensive Care Med 38, 2042–2046 (2012). https://doi.org/10.1007/s00134-012-2733-7

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  • DOI: https://doi.org/10.1007/s00134-012-2733-7

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