Home⇛The PCMC Journal⇛vol. 11 no. 1 (2015)

Blood Lactate as Predictor of Serious Bacterial Infection in Pediatric Patients Seen at the Emergency Room of PCMC

Paula Pilar G. Evangelista | Zara Marie S. Zamora | Mary Antonette C. Madrid | Ma Victoria C. Ribaya

Discipline: medicine by specialism

 

Abstract:

OBJECTIVES: The main objective was to evaluate the predictive value of blood lactate as risk factor for developing serious bacterial infection (SBI) in pediatric patients at the emergency room. Specifically, to determine the near-patient-test (NPT) lactate values of the patient population, to determine the relationship between NPT-lactate level and SBI, and to compute for the relative risk for SBlusing the NPT-lactate. DESIGN: Prospective cohort study PATIENTS AND METHODS: The study was conducted from July to September 2011 at the ER of PCMC. Patients less than 19 years old presenting with an infection-related illness and fulfilling inclusion criteria were included. Arterial blood sample was used for NPT-lactate level, WBC and ANC. A panel of infectious disease experts confirmed classification as SBI, non-SBI or viral infection based on clinical and diagnostic findings. Analysis and correlation of data were done using means and standard deviations, frequency counts and percentages, ANOVA, post-hoc t-test, Chi-square, Fischer's Exact Testand ROC Analysis. RESULTS: One hundred eighty eight subjects were included. Of this, 107 (56.6%) were SBI, 35 (18.5%) were non-SBI and 46 (24.9%) had viral infection. The mean NPT-lactate for the SBI category was 1.42 mmol/L. The levels in the NSBI and viral categories were 0.746 and 0.643 mmol/L respectively. Both negative and positive microbiological results had high levels of NPTlactate while there was significant correlation between radiologic methods and the NPT-lactate levels. Sensitivity was highest at 71.96% with NPT-lactate level of >0.8 mmol/L while specificity was highest at 97.14% with NPT-lactate level of >1.3 mmol/L. Positive predictive value (PPV) was highest at 98.1 with NPT-lactate of >1.3 mmol/L while negative predictive value (NPV) was highest at 64.4 with NPT-lactate of >0.9 mmol/L. The relative risk of having SBl is 2.3 x greater than that of NSBI or viral infection if the NPT-lactate level is >0.9 mmol/L. The relative risk of having SBl is 1.6x greater than that of NSBI if the NPT-lactate is >1.3 mmol/L. CONCLUSIONS AND RECOMMENDATIONS: The NPT-lactate is a useful tool in predicting SBI in pediatric patients at the ER setting. This may be beneficial in the management and treatment of ER patients so that accurate diagnostics can be requested, prompt administration of appropriate antibiotics and timely admission to the proper services can be facilitated.



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