Epicentre, Paris, France.
UMR 8257, Université Paris Descartes, Paris, France.
Pediatr Res. 2020 Oct;88(4):605-611. doi: 10.1038/s41390-020-0783-z. Epub 2020 Jan 29.
The prognostic significance of hyperlactatemia in young children with liver injury suspected to be attributed to repeated supratherapeutic doses of acetaminophen remain understudied.
We conducted a retrospective medical chart review including children aged <5 years admitted with hepatocellular injury. The study was conducted in Bardnesville Junction Hospital operated by Médecins Sans Frontières in Monrovia, Liberia.
We analyzed 95 children with liver injury in whom a blood lactate measurement on admission was available. Eighty children (84%) were aged <2 years; 49 children (52%) died during hospitalization. The median acetaminophen concentration on admission was 20 mg/L with 60 (70%) children presenting concentrations exceeding 10 mg/L. Median lactate was significantly higher in children who died (10.7 mmol/L; interquartile range (IQR): 8.5-15.7) than those who survived (6.1 mmol/L; IQR: 4.1-8.5), P value < 0.001). The optimal threshold obtained was 7.2 mmol/L with a sensitivity of 84% and specificity 70% (area under curve = 0.80). The previously established thresholds of 3.5 and 4 mmol/L lactate had very low specificity identifying non-survival in children included in this study.
In this setting, young children with ALF possibly attributed to acetaminophen toxicity were unlikely to survive if the venous blood lactate concentration exceeded 7.2 mmol/L.
在疑似因反复摄入超治疗剂量对乙酰氨基酚而导致肝损伤的幼儿中，高乳酸血症的预后意义仍研究不足。
我们进行了一项回顾性病历审查，纳入了在利比里亚蒙罗维亚无国界医生组织运营的 Bardnesville Junction 医院就诊的患有肝细胞损伤的年龄<5 岁的儿童。
我们分析了 95 名有入院时血乳酸测量值的肝损伤儿童。80 名儿童（84%）年龄<2 岁；49 名儿童（52%）在住院期间死亡。入院时对乙酰氨基酚浓度中位数为 20mg/L，60 名儿童（70%）浓度超过 10mg/L。死亡儿童的中位乳酸值明显高于存活儿童（10.7mmol/L；四分位距[IQR]：8.5-15.7），P 值<0.001）。最佳阈值为 7.2mmol/L，敏感性为 84%，特异性为 70%（曲线下面积[ AUC ]=0.80）。在此研究纳入的儿童中，乳酸阈值 3.5 和 4mmol/L 的特异性非常低，无法识别非存活情况。
在这种情况下，如果静脉血乳酸浓度超过 7.2mmol/L，可能归因于对乙酰氨基酚毒性的急性肝衰竭幼儿存活的可能性不大。
