title: Lactate as a predictor of mortality in Malawian children with WHO-defined pneumonia.
abstract: OBJECTIVE
  To determine whether blood lactate measured at the time of presentation to hospital predicted outcome in children with pneumonia in Malawi, and to understand the factors associated with high blood lactate concentrations in pneumonia.
  
  
  METHODS
  Analysis of data from a prospective study of children presenting to Queen Elizabeth Central Hospital, Blantyre, with WHO-defined severe or very severe pneumonia.
  
  
  RESULTS
  Among 233 children with pneumonia, the median serum lactate concentration was 2.7 mmol/l (IQR 1.8-4.4 mmol/l). 77 children (33%) had a lactate concentration of 2.1-4.0 mmol/l, and 72 children (31%) had a lactate concentration >4.0 mmol/l. 92% of children who died (23/25) had lactate >2.0 mmol/l at the time of admission to hospital. There were 10 deaths (13%) among 77 children who had a serum lactate concentration of 2.1-4.0 mmol/l; and 13 deaths (18%) in the 72 children who had lactate >4.0 mmol/l. The relative risk of death if the lactate level was above 2 mmol/l was 7.48 (1.72-32.6); sensitivity 0.92, specificity 0.39, positive predictive value 0.15, negative predictive value 0.98. Multivariable analysis showed that hypoxaemia, hyperlactataemia and age ≤12 months were independent risk factors for death from pneumonia.
  
  
  CONCLUSIONS
  Used in conjunction with clinical risk factors and pulse oximetry for measuring oxygen saturation, lactate could play an important role in identifying the sickest patients with pneumonia in developing countries.
authors.affiliation: Centre for International Child Health, University of Melbourne, Department of Paediatrics, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia.
authors.forename: Bharat
authors.initials: B
authors.lastname: Ramakrishna
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Graham
authors.forename: Ajib
authors.initials: A
authors.lastname: Phiri
authors.forename: Limangeni
authors.initials: L
authors.lastname: Mankhambo
authors.forename: Trevor
authors.initials: T
authors.lastname: Duke
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D019344:Lactic Acid / Q000097:blood*; D008295:Malawi / Q000453:epidemiology; D008297:Male; D010092:Oximetry / Q000379:methods; D010100:Oxygen / Q000097:blood; D011014:Pneumonia / Q000097:blood / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D019344:Lactic Acid; D010100:Oxygen