Clinical value of blood lactate in predicting the prognosis of neonatal sepsis
SUN Yu-Shan, YU Jia-Lin
Pediatric Research Institute, Children's Hospital of Chongqing Medical University/Ministry of Education Key Laboratory of Child Development and Disorders/China International Science and Technology Cooperation Base of Child Development and Critical Disorders/Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
Abstract:Objective To explore the clinical value of arterial blood lactate level in predicting the prognosis of neonatal sepsis. Methods The clinical data of 301 cases of neonatal sepsis were collected, which mainly included biochemical indicators such as blood lactate on admission, C-reactive protein, and procalcitonin. ROC curves were plotted to evaluate the value of lactate level on admission in predicting the prognosis of neonatal sepsis. Results The mortality rate was significantly higher for full-term infants in the severely-elevated lactate group than in the mildly-elevated lactate group and the normal lactate group (26.1% vs 3.1% and 0%; P < 0.017). The poor prognosis group had a significantly increased lactate level on admission compared with the good prognosis group (6.5±5.1 mmol/L vs 3.6±1.7 mmol/L; P < 0.05). The sensitivity and specificity of blood lactate level on admission (cutoff value:6.15 mmol/L) were 0.545 and 0.919 respectively, in predicting the prognosis of neonatal sepsis. Conclusions Early blood lactate level can be used as a biochemical parameter to predict the prognosis of neonatal sepsis as it has a high specificity but a low sensitivity.
Zea-Vera A, Ochoa TJ. Challenges in the diagnosis and management of neonatal sepsis[J]. J Trop Pediatr, 2015, 61(1):1-13.
[5]
Ryoo SM, Lee J, Lee YS, et al. Lactate level versus lactate clearance for predicting mortality in patients with septic shock defined by sepsis-3[J]. Crit Care Med, 2018, 46(6):e489-e495.
[6]
Jia Y, Wang Y, Yu X. Relationship between blood lactic acid, blood procalcitonin, C-reactive protein and neonatal sepsis and corresponding prognostic significance in sick children[J]. Exp Ther Med, 2017, 14(3):2189-2193.
Mohammed I, Nonas SA. Mechanisms, detection, and potential management of microcirculatory disturbances in sepsis[J]. Crit Care Clin, 2010, 26(2):393-408.
[9]
Russell J, Lee T, Singer J, et al. The Septic Shock 3.0 definition and trials:a vasopressin and septic shock trial experience[J]. Crit Care Med, 2017, 45(6):940-948.
[10]
Rojas-Marcial C, Pedraza-Zárate MÁ, Bautista-Barranco H, et al. Lactate levels with regards to the pulse pressure in patients with shock[J]. Rev Med Inst Mex Seguro Soc, 2016, 54(1):16-19.
Cantey JB, Baird SD. Ending the culture of culture-negative sepsis in the neonatal ICU[J]. Pediatrics, 2017, 140(4).pii:e20170044.
[13]
Schuetz P, Birkhahn R, Sherwin R, et al. Serial procalcitonin predicts mortality in severe sepsis patients:results from the multicenter procalcitonin monitoring sepsis (MOSES) study[J]. Crit Care Med, 2017, 45(5):781-789.
Yang A, Liu J, Yue L, et al. Neutrophil CD64 combined with PCT, CRP and WBC improves the sensitivity for the early diagnosis of neonatal sepsis[J]. Clin Chem Lab Med, 2016, 54(2):345-351.
[16]
Perrone S, Lotti F, Longini M, et al. C reactive protein in healthy term newborns during the first 48 hours of life[J]. Arch Dis Child Fetal Neonatal Ed, 2018, 103(2):F163-F166.
Arora S, Singh P, Singh PM, et al. Procalcitonin levels in survivors and nonsurvivors of sepsis:systematic review and meta-analysis[J]. Shock, 2015, 43(3):212-221.
[19]
Meisner M. Pathobiochemistry and clinical use of procalcitonin[J]. Clin Chim Acta, 2002, 323(1-2):17-29.
[20]
Fukuzumi N, Osawa K, Sato I, et al. Age-specific percentile-based reference curve of serum procalcitonin concentrations in Japanese preterm infants[J]. Sci Rep, 2016, 6:23871.
Ha T, Shin T, Jo IJ, et al. Lactate clearance and mortality in septic patients with hepatic dysfunction[J]. Am J Emerg Med, 2016, 34(6):1011-1015.
[24]
Casserly B, Phillips G, Schorr C, et al. Lactate measurements in sepsis-induced tissue hypoperfusion:results from the Surviving Sepsis Campaign database[J]. Crit Care Med, 2015, 43(3):567-573.
Scott HF, Brou L, Deakyne SJ, et al. Lactate clearance and normalization and prolonged organ dysfunction in pediatric sepsis[J]. J Pediatr, 2016, 170:149-155.e1-4.
[28]
Arnold RC, Shapiro NI, Jones AE, et al. Multicenter study of early lactate clearance as a determinant of survival in patients with presumed sepsis[J]. Shock, 2009, 32(1):35-39.