Bui-Binh-Bao Son, Nguyen-Thi-My Trang, Nguyen-Duy-Nam Anh, Kim Hoa Nguyen Thi, Pham-Van Dung
Hue University of Medicine and Pharmacy, Hue University, Hue City, Thua Thien Hue Province, Vietnam.
Binh Dinh General Hospital, Quy Nhon City, Binh Dinh Province, Vietnam.
Glob Pediatr Health. 2021 Nov 29;8:2333794X211060806. doi: 10.1177/2333794X211060806. eCollection 2021.
Pneumonia is a major cause of morbidity and mortality in children globally. Lactate, a product of anaerobic cellular metabolism, has been used as an indicator of poor tissue oxygenation and cellular hypoxia. Our objective was to determine whether serum lactate concentration at hospital admission predicted mortality in children aged 2 months to 5 years with pneumonia. Two hundred and eighty-one pediatric patients admitted to the Department of Pediatrics of a provincial hospital with WHO-defined pneumonia and severe pneumonia were included; of whom, 8 died during hospital stay. The median serum lactate concentration was 4.8 mmol/l (IQR 2.6-6.9) among children who died and 3.6 mmol/l (IQR 2.8-4.3) among children who survived ( > .05); 4.1 mmol/l (IQR 2.7-4.7) among children with severe pneumonia and 3.5 mmol/l (IQR 2.8-4.3) among children with pneumonia ( > .05). Serum lactate concentration had a low value in predicting pneumonia-related mortality (AUC 0.68, 95% CI 0.62-0.73); and the concentration cut-off of >4.06 mmol/l had the best sensitivity and specificity (75% and 68.9%, respectively) with a 2.4-fold risk of death (LR+ 2.4; 95% CI 1.6-3.7). Although hyperlactatemia was associated with severity and mortality in children 2 months to 5 years of age with pneumonia, its benefit was unclear.
肺炎是全球儿童发病和死亡的主要原因。乳酸是无氧细胞代谢的产物，一直被用作组织氧合不良和细胞缺氧的指标。我们的目的是确定入院时血清乳酸浓度是否可预测2个月至5岁肺炎患儿的死亡率。纳入了一家省级医院儿科收治的281例符合世界卫生组织定义的肺炎和重症肺炎的儿科患者；其中8例在住院期间死亡。死亡儿童的血清乳酸浓度中位数为4.8 mmol/l（四分位间距2.6 - 6.9），存活儿童为3.6 mmol/l（四分位间距2.8 - 4.3）（P>0.05）；重症肺炎儿童为4.1 mmol/l（四分位间距2.7 - 4.7），肺炎儿童为3.5 mmol/l（四分位间距2.8 - 4.3）（P>0.05）。血清乳酸浓度在预测肺炎相关死亡率方面价值较低（曲线下面积0.68，95%可信区间0.62 - 0.73）；浓度截断值>4.06 mmol/l时敏感性和特异性最佳（分别为75%和68.9%），死亡风险增加2.4倍（阳性似然比2.4；95%可信区间1.6 - 3.7）。虽然高乳酸血症与2个月至5岁肺炎患儿的病情严重程度和死亡率相关，但其作用尚不清楚。
