Point-of-Care Measurement of Blood Lactate in Children Admitted With Febrile Illness to an African District Hospital


Mtove, G; Nadjm, B; Hendriksen, ICE; Amos, A; Muro, F; Todd, J; Reyburn, H; (2011) Point-of-Care Measurement of Blood Lactate in Children Admitted With Febrile Illness to an African District Hospital. Clinical infectious diseases, 53 (6). pp. 548-554. ISSN 1058-4838 DOI: https://doi.org/10.1093/cid/cir471

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Abstract

Background. 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. Methods. 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. Results. 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. Conclusions. 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.

Item Type: Article
Keywords: severe malaria, lactic-acidosis, interobserver variation, prognostic-significance, clinical signs, tanzania, balance, sepsis
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Disease Control
Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
Faculty of Epidemiology and Population Health > Dept of Population Health (2012- ) > Dept of Population Studies (1974-2012)
Faculty of Epidemiology and Population Health > Dept of Population Health (2012- )
Research Centre: Population Studies Group
PubMed ID: 21865191
Web of Science ID: 294363100014
URI: http://researchonline.lshtm.ac.uk/id/eprint/88

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