Pediatric Malaria with Respiratory Distress: Prognostic Significance of Point-of-Care Lactate
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Patient Inclusion Criteria
2.2. Setting
2.3. Sample Size
2.4. Study Procedures
2.5. Clinical Definitions
2.6. Statistical Analysis
2.7. Ethical Approval and Informed Consent
3. Results
3.1. Handheld Blood Lactate Predicts Subsequent Mortality in Children with Malaria and RD
3.2. Lactate Clearance as a Predictor of Mortality
3.3. Signs of Increased Work of Breathing Are Associated with Hyperlactatemia and Mortality
3.4. Elevated Lactate Is Associated with Impaired Tissue Perfusion
3.5. Elevated Lactate Is Not Associated with Hypoxemia
3.6. Elevated Lactate Is Associated with Anemia and Low Global Oxygen Delivery
3.7. Elevated Lactate Is Associated with Higher Parasite Density
3.8. Association with Acute Kidney Injury
4. Discussion
4.1. Clinical Significance of Hyperlactatemia in Malaria with RD
4.2. Mechanisms of Hyperlactatemia in Malaria with RD
4.3. Study Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Entire Cohort (n = 1324) | Lactate ≤5 mmol/L (n = 738) | Lactate >5 mmol/L (n = 586) | p-Value | |
---|---|---|---|---|
Demographics | ||||
Female sex | 611 (46) | 354 (48) | 257 (44) | 0.14 |
Age [years], median (IQR) | 1.4 (0.75–2.4) | 1.2 (0.75–2.3) | 1.4 (0.75–2.5) | 0.43 |
History | ||||
Cough | 1147 (87) | 649 (88) | 498 (85) | 0.14 |
Difficulty breathing | 975 (74) | 537 (73) | 438 (75) | 0.48 |
Lethargy | 438 (33) | 195 (26) | 243 (42) | <0.0001 |
Convulsions | 329 (25) | 180 (24) | 149 (25) | 0.71 |
Unable to feed/drink | 687 (52) | 342 (46) | 345 (59) | <0.0001 |
Vomiting | 524 (40) | 257 (35) | 267 (46) | <0.0001 |
Diarrhea | 352 (27) | 188 (26) | 164 (28) | 0.35 |
Physical examination findings | ||||
Weight [kg], median (IQR) | 9 (7.7–12) | 9 (7.5–12) | 9.5 (8–12) | 0.38 |
Wasting 1 | 202 (16) | 114 (16) | 88 (16) | >0.99 |
Length/height [cm], median (IQR) | 72 (65–83) | 72 (65–83) | 72 (65–84) | 0.87 |
Stunting 2 | 651 (51) | 358 (50) | 293 (53) | 0.37 |
Heart Rate (bpm), median (IQR) | 160 (140–170) | 150 (130–170) | 160 (140–180) | 0.00036 |
Tachycardia 2 | 767 (58) | 390 (53) | 377 (65) | <0.0001 |
Respiratory rate (bpm), median (IQR) | 52 (42–62) | 50 (40–60) | 54 (44–62) | 0.0015 |
Tachypnea 3 | 834 (64) | 444 (61) | 390 (68) | 0.013 |
Oxygen saturation (%), median (IQR) | 89 (84–98) | 89 (84–98) | 90 (85–98) | 0.098 |
Hypoxemia (SaO2 < 90%) | 667 (51) | 392 (53) | 275 (47) | 0.033 |
Temperature [°C], median (IQR) | 38 (37–38) | 38 (37–39) | 38 (37–38) | <0.0001 |
Fever 4 | 798 (61) | 470 (64) | 328 (56) | 0.0045 |
Altered level of consciousness 5 | 458 (35) | 197 (27) | 261 (45) | <0.0001 |
Capillary refill time [seconds] | <0.0001 | |||
<2 | 888 (68) | 545 (75) | 343 (59) | |
2–3 | 286 (22) | 128 (18) | 158 (27) | |
>3 | 141 (11) | 58 (7.9) | 83 (14) | |
Chest indrawing | 1086 (82) | 615 (83) | 471 (80) | 0.19 |
Wheeze | 368 (54) | 247 (59) | 121 (46) | 0.0018 |
Stridor | 206 (30) | 122 (29) | 84 (32) | 0.45 |
Danger signs 6 | 1070 (81) | 567 (77) | 503 (86) | <0.0001 |
Treatment | ||||
Artesunate | 771 (58) | 440 (60) | 331 (56) | 0.27 |
Quinine | 434 (33) | 226 (31) | 208 (35) | 0.069 |
Artemether injection | 41 (3.1) | 14 (1.9) | 27 (4.6) | 0.0076 |
Artemether-lumefantrine (oral) | 143 (11) | 88 (12) | 55 (9.4) | 0.16 |
Supplemental oxygen | 681 (53) | 399 (56) | 282 (50) | 0.058 |
Outcome | <0.0001 | |||
Discharged | 1043 (79) | 627 (86) | 416 (71) | |
Death | 84 (6.4) | 17 (2.3) | 67 (11) | |
Transferred to another facility | 101 (7.7) | 46 (6.3) | 55 (9.4) | |
Absconded | 89 (6.8) | 43 (5.9) | 46 (7.9) |
Univariable | Multivariable * | |||
---|---|---|---|---|
HR | p-Value | aHR | p-Value | |
Fixed effects | ||||
Female sex | 0.68 (0.43–1.1) | 0.093 | 0.77 (0.48–1.2) | 0.25 |
Age | 0.99 (0.82–1.2) | 0.38 | 1.0 (0.85–1.3) | 0.73 |
LODS | <0.0001 | <0.0001 | ||
0 | 1.0 (reference) | 1.0 (reference) | ||
1 | 1.2 (0.29–4.8) | 1.6 (0.36–6.7) | ||
2 | 7.0 (2.1–23) | 9.0 (2.5–33) | ||
3 | 14 (4.5–47) | 18 (5.0–65) | ||
Lactate > 5 mmol/L | 5.3 (3.1–9.0) | <0.0001 | 3.0 (1.8–5.3) | <0.0001 |
Random effect | ||||
Site | Variance 1.2 |
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Mitran, C.; Opoka, R.O.; Conroy, A.L.; Namasopo, S.; Kain, K.C.; Hawkes, M.T. Pediatric Malaria with Respiratory Distress: Prognostic Significance of Point-of-Care Lactate. Microorganisms 2023, 11, 923. https://doi.org/10.3390/microorganisms11040923
Mitran C, Opoka RO, Conroy AL, Namasopo S, Kain KC, Hawkes MT. Pediatric Malaria with Respiratory Distress: Prognostic Significance of Point-of-Care Lactate. Microorganisms. 2023; 11(4):923. https://doi.org/10.3390/microorganisms11040923
Chicago/Turabian StyleMitran, Catherine, Robert O. Opoka, Andrea L. Conroy, Sophie Namasopo, Kevin C. Kain, and Michael T. Hawkes. 2023. "Pediatric Malaria with Respiratory Distress: Prognostic Significance of Point-of-Care Lactate" Microorganisms 11, no. 4: 923. https://doi.org/10.3390/microorganisms11040923