title: Lactate Clearance and Normalization and Prolonged Organ Dysfunction in Pediatric Sepsis.
abstract: OBJECTIVE
  To evaluate whether lactate clearance and normalization during emergency care of pediatric sepsis is associated with lower rates of persistent organ dysfunction.
  
  
  METHODS
  This was a prospective cohort study of 77 children <18 years of age in the emergency department with infection and acute organ dysfunction per consensus definitions. In consented patients, lactate was measured 2 and/or 4 hours after an initial lactate; persistent organ dysfunction was assessed through laboratory and physician evaluation at 48 hours. A decrease of ≥ 10% from initial to final level was considered lactate clearance; a final level < 2 mmol/L was considered lactate normalization. Relative risk (RR) with 95% CIs, adjusted in a log-binomial model, was used to evaluate associations between lactate clearance/normalization and organ dysfunction.
  
  
  RESULTS
  Lactate normalized in 62 (81%) patients and cleared in 70 (91%). The primary outcome, persistent 48-hour organ dysfunction, was present in 32 (42%). Lactate normalization was associated with decreased risk of persistent organ dysfunction (RR 0.46, 0.29-0.73; adjusted RR 0.47, 0.29-0.78); lactate clearance was not (RR 0.70, 0.35-1.41; adjusted RR 0.75, 0.38-1.50). The association between lactate normalization and decreased risk of persistent organ dysfunction was retained in the subgroups with initial lactate ≥ 2 mmol/L and hypotension.
  
  
  CONCLUSIONS
  In children with sepsis and organ dysfunction, lactate normalization within 4 hours was associated with decreased persistent organ dysfunction. Serial lactate level measurement may provide a useful prognostic tool during the first hours of resuscitation in pediatric sepsis.
authors.affiliation: Children's Hospital Colorado, Aurora, CO; Section of Emergency Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO. Electronic address: halden.scott@childrenscolorado.org.
authors.forename: Halden F
authors.initials: HF
authors.lastname: Scott
authors.affiliation: Section of Emergency Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Lina
authors.initials: L
authors.lastname: Brou
authors.affiliation: Children's Hospital Colorado, Aurora, CO.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Deakyne
authors.affiliation: Colorado School of Public Health, Aurora, CO; Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado and Children's Hospital Colorado, Aurora, CO.
authors.forename: Diane L
authors.initials: DL
authors.lastname: Fairclough
authors.affiliation: Children's Hospital Colorado, Aurora, CO; Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado and Children's Hospital Colorado, Aurora, CO; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Allison
authors.initials: A
authors.lastname: Kempe
authors.affiliation: Children's Hospital Colorado, Aurora, CO; Section of Emergency Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Lalit
authors.initials: L
authors.lastname: Bajaj
mesh_terms: D015415:Biomarkers / Q000097:blood; D002648:Child; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D006801:Humans; D007022:Hypotension / Q000150:complications; D019344:Lactic Acid / Q000097:blood*; D009102:Multiple Organ Failure / Q000097:blood* / Q000209:etiology; D063305:Organ Dysfunction Scores; D011379:Prognosis; D018805:Sepsis / Q000097:blood* / Q000150:complications; D013997:Time Factors
chemical_list: D015415:Biomarkers; D019344:Lactic Acid