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Paediatric Intensive Care
Unit, 9th Floor, Guy's Hospital, St Thomas's Street, London SE10 8JA
Correspondence to: Dr Hatherill.
Accepted 5 June 1997
OBJECTIVE
To assess the value of sequential
lactate measurement in predicting postoperative mortality after surgery
for complex congenital heart disease in children.
DESIGNProspective observational study.
SETTINGSixteen bedded paediatric intensive care
unit (PICU).
SUBJECTSNinety nine children ( 90 survivors,
nine non-survivors).
MEASUREMENTSSerum lactate and base deficit were
measured on admission and every six hours thereafter. Data were
analysed by Mann-Whitney and Fisher's exact tests.
RESULTSThere was considerable overlap in initial
lactate values between the survivor and non-survivor groups. Initial
lactate was significantly raised in non-survivors (median 8.7, range
1.9-17.6 mmol/l) compared with survivors (median 2.4, range 0.6-13.6
mmol/l) (p = 0.0002). Twenty one patients (21.1%) with initial lactate concentrations greater than 4.5 mmol/l survived to PICU discharge. Using receiver operating characteristic analysis an initial lactate of
6 mmol/l had the optimum predictive value for mortality. Initial postoperative serum lactate >6 mmol/l predicted mortality with sensitivity 78%, specificity 83%, and positive predictive value of
only 32%.
CONCLUSIONInitial lactate concentrations have
poor positive predictive value for mortality. The routine measurement
of lactate for this purpose cannot be justified in clinical practice.
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