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dc.contributor.authorAramburo, A
dc.contributor.authorTodd, Jim
dc.contributor.authorGeorge, Elizabeth C.
dc.contributor.authorKiguli, Sarah
dc.contributor.authorOlupot-Olupot, Peter
dc.contributor.authorOpoka, Robert O
dc.contributor.authorEngoru, Charles
dc.contributor.authorAkech, Samuel O
dc.contributor.authorNyeko, Richard
dc.contributor.authorMtove, George
dc.contributor.authorGibb, Diana M
dc.contributor.authorBabiker, Abdel G
dc.contributor.authorMaitland, Kathryn
dc.date.accessioned2021-08-09T08:00:47Z
dc.date.available2021-08-09T08:00:47Z
dc.date.issued2018
dc.identifier.citationAramburo, A., Todd, J., George, E. C., Kiguli, S., Olupot-Olupot, P., Opoka, R. O., ... & Maitland, K. (2018). Lactate clearance as a prognostic marker of mortality in severely ill febrile children in East Africa. BMC medicine, 16(1), 1-12.en_US
dc.identifier.urihttps://hdl.handle.net/123456789/310
dc.description.abstractBackground: Hyperlactataemia (HL) is a biomarker of disease severity that predicts mortality in patients with sepsis and malaria. Lactate clearance (LC) during resuscitation has been shown to be a prognostic factor of survival in critically ill adults, but little data exist for African children living in malaria-endemic areas. Methods: In a secondary data analysis of severely ill febrile children included in the Fluid Expansion as Supportive Therapy (FEAST) resuscitation trial, we assessed the association between lactate levels at admission and LC at 8 h with all-cause mortality at 72 h (d72). LC was defined as a relative lactate decline ≥ 40% and/or lactate normalisation (lactate < 2.5 mmol/L). Results: Of 3170 children in the FEAST trial, including 1719 children (57%) with Plasmodium falciparum malaria, 3008 (95%) had a baseline lactate measurement, 2127 (71%) had HL (lactate ≥ 2.5 mmol/L), and 1179 (39%) had severe HL (≥ 5 mmol/L). Within 72 h, 309 children (10.3%) died, of whom 284 (92%) had baseline HL. After adjustment for potential confounders, severe HL was strongly associated with mortality (Odds Ratio (OR) 6.96; 95% CI 3.52, 13.76, p < 0.001). This association was not modified by malaria status, despite children with malaria having a higher baseline lactate (median 4.6 mmol/L vs 3 mmol/L; p < 0.001) and a lower mortality rate (OR = 0.42; p < 0.001) compared to non-malarial cases. Sensitivity and specificity analysis identified a higher lactate on admission cut-off value predictive of d72 for children with malaria (5.2 mmol/L) than for those with other febrile illnesses (3.4 mmol/L). At 8 h, 2748/3008 survivors (91%) had a lactate measured, 1906 (63%) of whom had HL on admission, of whom 1014 (53%) fulfilled pre-defined LC criteria. After adjustment for confounders, LC independently predicted survival after 8 h (OR 0.24; 95% CI 0.14, 0.42; p < 0.001). Absence of LC (< 10%) at 8 h was strongly associated with death at 72 h (OR 4. 62; 95% CI 2.7, 8.0; p < 0.001). Conclusions: Independently of the underlying diagnosis, HL is a strong risk factor for death at 72 h in children admitted with severe febrile illnesses in Africa. Children able to clear lactate within 8 h had an improved chance of survival. These findings prompt the more widespread use of lactate and LC to identify children with severe disease and monitor response to treatment.en_US
dc.language.isoenen_US
dc.publisherBMC Medicineen_US
dc.subjectHyperlactataemiaen_US
dc.subjectChildrenen_US
dc.subjectLactate clearanceen_US
dc.subjectEast Africaen_US
dc.subjectMortalityen_US
dc.subjectHospital admissionen_US
dc.subjectClinical trialsen_US
dc.subjectRandomiseden_US
dc.subject, Sepsisen_US
dc.subjectMalariaen_US
dc.titleLactate clearance as a prognostic marker of mortality in severely ill febrile children in East Africaen_US
dc.typeArticleen_US


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