Relationship between Initial Lactate Level with Mortality in Children with Sepsis and Septic Shock: A Comparison with the PRISM-3 Score

Abstract

Abstract Objective  Sepsis and septic shock are leading causes of mortality and morbidity in intensive care units. Our study aimed to compare the pediatric risk of mortality (PRISM-3) score, which is used for predicting mortality risk among critically ill patients in pediatric intensive care units, with laboratory parameters, particularly lactate parameters. Methods  This study included 38 patients aged 1 month to 18 years who were managed for sepsis and septic shock in a pediatric intensive care unit. Lactate, D-dimer, troponin T, and N-terminal prohormone of brain natriuretic peptide levels were measured at the 0th and 24th hours. The patients were divided into survivors and nonsurvivors and those with septic shock and those without. Results  There were a total of 38 patients with a median age of 12 months, of whom 17 (44.7%) were males and 21 (55.3%) were females. Six (15.8%) patients died within 7 days after the diagnosis. Nonsurvivors had significantly higher median values of PRISM-3 ( p  = 0.002), C-reactive protein ( p  = 0.046), and partial arterial carbon dioxide pressure ( p  = 0.041). PRISM-3 showed a good discriminatory power (area under the curve [AUROC] = 0.878; p  < 0.0001) and baseline lactate level showed a moderate level of discriminatory power (AUROC = 0.734 p  = 0.0254) for early mortality within 7 days. Conclusion  PRISM-3 and baseline lactate predict early mortality in children with sepsis and septic shock. We suggest that adding lactate, which is not included in the PRISM-3 score, to the score may increase the score's predictive ability for mortality. We believe, however, that randomized, controlled, multicenter studies with larger sample sizes should be conducted to test this hypothesis.