title: Point-of-care measurement of blood lactate in children admitted with febrile illness to an African District Hospital.
abstract: BACKGROUND
  Lactic acidosis is a consistent predictor of mortality owing to severe infectious disease, but its detection in low-income settings is limited to the clinical sign of "deep breathing" because of the lack of accessible technology for its measurement. We evaluated the use of a point-of-care (POC) diagnostic device for blood lactate measurement to assess the severity of illness in children admitted to a district hospital in Tanzania.
  
  
  METHODS
  Children between the ages of 2 months and 13 years with a history of fever were enrolled in the study during a period of 1 year. A full clinical history and examination were undertaken, and blood was collected for culture, microscopy, complete blood cell count, and POC measurement of blood lactate and glucose.
  
  
  RESULTS
  The study included 3248 children, of whom 164 (5.0%) died; 45 (27.4%) of these had raised levels of blood lactate (>5 mmol/L) but no deep breathing. Compared with mortality in children with lactate levels of ≤ 3 mmol/L, the unadjusted odds of dying were 1.6 (95% confidence interval [CI].8-3.0), 3.4 (95% CI, 1.5-7.5), and 8.9 (95% CI, 4.7-16.8) in children with blood lactate levels of 3.1-5.0, 5.1-8.0, or >8.0 mmol/L, respectively. The prevalence of raised lactate levels (>5 mmol/L) was greater in children with malaria than in children with nonmalarial febrile illness (P < .001) although the associated mortality was greater in slide-negative children.
  
  
  CONCLUSIONS
  POC lactate measurement can contribute to the assessment of children admitted to hospital with febrile illness and can also create an opportunity for more hospitals in resource-poor settings to participate in clinical trials of interventions to reduce mortality associated with hyperlactatemia.
authors.affiliation: National Institute for Medical Research, Amani Centre, Tanzania.
authors.forename: George
authors.initials: G
authors.lastname: Mtove
authors.forename: Behzad
authors.initials: B
authors.lastname: Nadjm
authors.forename: Ilse C E
authors.initials: IC
authors.lastname: Hendriksen
authors.forename: Ben
authors.initials: B
authors.lastname: Amos
authors.forename: Florida
authors.initials: F
authors.lastname: Muro
authors.forename: Jim
authors.initials: J
authors.lastname: Todd
authors.forename: Hugh
authors.initials: H
authors.lastname: Reyburn
mesh_terms: D000293:Adolescent; D000740:Anemia / Q000097:blood; D001424:Bacterial Infections / Q000097:blood; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005334:Fever / Q000097:blood*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D019344:Lactic Acid / Q000097:blood*; D016015:Logistic Models; D016778:Malaria, Falciparum / Q000097:blood; D008297:Male; D009026:Mortality; D019095:Point-of-Care Systems; D012372:ROC Curve; D012307:Risk Factors; D013636:Tanzania
chemical_list: D019344:Lactic Acid