Elliot Long, Stephen Hearps, Warwick Butt, Tom Rozen, James Williams, Amanda Williams, Ben Gelbart, Sarah McNab, Meredith L Borland, Jarrod Cross, Shefali Jani, Marino Festa, Eunicia Tan, Natalie Phillips, Sainath Raman, Amit Kochar, Subodh Ganu, Simon Craig, Anna Lithgow, Emma Whyte, Arjun Rao, Stuart R Dalziel, Shane George, Franz E Babl, Pediatric Research in Emergency Departments International Collaborative (PREDICT) Network
In this secondary analysis of the 2021-2023 SENTINEL dataset, we have found that at the time children are hospitalized with suspected community-acquired sepsis, an initial venous lactate greater than or equal to 3.5 mmol/L has an acceptable-to-fair association with subsequent need for ECLS, or death, within 72 hours. Clinicians will need to decide whether such testing on its own is useful in decision-making.
OBJECTIVES: In pediatric patients with sepsis, we hypothesized that the initial venous lactate concentration would be associated with subsequent need for extracorporeal life support (ECLS) or death within 72 hours.
DESIGN: A planned secondary analysis of data from the multicenter, two-country Sepsis Epidemiology Emergency Departments (SENTINEL) study, collected 2021-2023.
SETTING: Acute care hospitals in Australia and New Zealand.
PATIENTS: SENTINEL participants were children of 0 to less than 18 years with suspected sepsis admitted to the hospital through 11 emergency departments.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: We used the initial venous lactate concentration (sampling within 4 hr of hospital arrival) as an explanatory variable for subsequent need for ECLS or death within 72 hours. In 4806 children, with a median (interquartile range [IQR]) age of 1.9 years (IQR, 0.2-6.7 yr), 2651 children (55.2%) were males, and 33 children (0.7%) received ECLS or died within 72 hours. The best-performing initial lactate concentration associated with ECLS or death within 72 hours was 3.5 mmol/L and was observed in 745 of 4806 children (15.5%), including 24 of 33 children requiring ECLS or who died within 72 hours. As a "diagnostic" test, lactate greater than or equal to 3.5 mmol/L had sensitivity (95% CI) of 72.7% (95% CI, 54.5-86.7%), specificity of 84.9% (95% CI, 83.9-85.9%), and area under the receiver-operating characteristics curve of 0.79 (95% CI, 0.71-0.87) for ECLS or death within 72 hours, which are in the acceptable-to-fair category. That is, a 4-hour lactate concentration greater than or equal to 3.5 mmol/L takes the pre- to posttest probability of ECLS/death from 0.7% to 3.2%.
CONCLUSIONS: In this secondary analysis of the 2021-2023 SENTINEL dataset, we have found that at the time children are hospitalized with suspected community-acquired sepsis, an initial venous lactate greater than or equal to 3.5 mmol/L has an acceptable-to-fair association with subsequent need for ECLS, or death, within 72 hours. Clinicians will need to decide whether such testing on its own is useful in decision-making.