title: Lactate and Lactate: Pyruvate Ratio in the Diagnosis and Outcomes of Pediatric Acute Liver Failure.
abstract: To assess the accuracy of blood lactate and lactate: pyruvate molar ratio (L:P) as a screen for mitochondrial, respiratory chain, or fatty acid oxidation disorders in children with pediatric acute liver failure (PALF); to determine whether serum lactate ≥ 2.5 mmol/L or L:P  ≥ 25 correlated with biochemical variables of clinical severity; and to determine whether lactate or L:P is associated with clinical outcome at 21 days.
  
  
  
  Retrospective review of demographic, clinical, laboratory, and outcome data for PALF study group participants who had lactate and pyruvate levels collected on the same day.
  
  
  
  Of 986 participants, 110 had lactate and pyruvate levels collected on the same day. Of the 110, the etiology of PALF was a mitochondrial disorder in 8 (7%), indeterminate in 65 (59%), and an alternative diagnosis in 37 (34%). Lactate, pyruvate, and L:P were similar among the 3 etiologic groups. There was no significant association between the initial lactate or L:P and biochemical variables of clinical severity or clinical outcome at 21 days.
  
  
  
  A serum lactate ≥ 2.5 mmol/L and/or elevated L:P was common in all causes of PALF, not limited to those with a mitochondrial etiology, and did not predict 21-day clinical outcome.
  
  
  
  ClinicalTrials.gov: NCT00986648.
authors.affiliation: Digestive Health Institute, Children's Hospital Colorado, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO. Electronic address: amy.feldman@childrenscolorado.org.
authors.forename: Amy G
authors.initials: AG
authors.lastname: Feldman
authors.affiliation: Digestive Health Institute, Children's Hospital Colorado, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Sokol
authors.affiliation: Epidemiology Data Center Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Regina M
authors.initials: RM
authors.lastname: Hardison
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Estella M
authors.initials: EM
authors.lastname: Alonso
authors.affiliation: Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Squires
authors.affiliation: Digestive Health Institute, Children's Hospital Colorado, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Narkewicz
mesh_terms: D000293:Adolescent; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D017114:Liver Failure, Acute / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D028361:Mitochondrial Diseases / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D019289:Pyruvic Acid / Q000097:blood*; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D019344:Lactic Acid; D019289:Pyruvic Acid
keywords: biomarker; liver transplant; mitochondrial liver disease