National Institute for Medical Research, Amani Centre, Tanzania.
Clin Infect Dis. 2011 Sep;53(6):548-54. doi: 10.1093/cid/cir471.
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.
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.
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.
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.
乳酸酸中毒是严重传染病导致死亡的一个一致预测指标，但由于缺乏可用于测量的便捷技术，在低收入环境中，其检测仅限于临床“深呼吸”征象。我们评估了使用即时诊断（POC）设备测量血乳酸来评估坦桑尼亚区医院收治的儿童疾病严重程度。
在 1 年期间，我们招募了患有发热史的 2 个月至 13 岁的儿童参与这项研究。进行了全面的临床病史和检查，并采集血液进行培养、显微镜检查、全血细胞计数和 POC 测量血乳酸和血糖。
该研究共纳入 3248 名儿童，其中 164 名（5.0%）死亡；45 名（27.4%）有血乳酸升高（>5 mmol/L）但无深呼吸。与血乳酸水平≤3 mmol/L 的儿童相比，乳酸水平为 3.1-5.0、5.1-8.0 或>8.0 mmol/L 的儿童，其死亡的未调整比值比分别为 1.6（95%置信区间[CI]，0.8-3.0）、3.4（95% CI，1.5-7.5）和 8.9（95% CI，4.7-16.8）。血乳酸水平升高（>5 mmol/L）的疟疾儿童比非疟疾发热儿童更为常见（P<0.001），尽管血涂片阴性儿童的相关死亡率更高。
POC 乳酸测量可有助于评估因发热而住院的儿童，也为资源匮乏地区的更多医院参与降低高乳酸血症相关死亡率的干预措施临床试验提供了机会。
