Abstract:

Objective To explore the predictive value of lactate level on the mortality in children with moderate to severe traumatic brain injury (TBI) within 3 hours after admission.Methods The retrospective study was conducted in Critical Care Medicine, Children′s Hospital of Chongqing Medical University from May 2011 to May 2014 including patients with moderate to severe TBI ［admission Glasgow Coma Scale (GCS) ≤13］. The included patients were divided into death group and survival group. The clinical data regarding age, gender, body weight and laboratory index within 3 h after admission (serum lactic acid, potassium, sodium, PLT count, D-Dimer) were collected to perform univariate and multivariate analysis between death and survival groups. The receiver operating characteristic curve of serum lactic acid was used to dertermine the optimal cut-off value, and the corresponding sensitivity and specificity were calculated.Results A total of 109 patients were enrolled, including 92 survivals and 17 deaths. The median lactate level,combined other organ injury ratio,the incidence of admission GCS≤8 and hypotension on admission of death group were higher than those of the survival group (4.9 vs 0.8 mmol·L-1,76.5% vs 42.4%,94.1% vs 45.7%,76.5% vs 7.6%; all P≤0.01). The plasma potassium level of death group was lower than that of survival group ［(3.4±0.5) vs (3.7±0.6) mmol·L-1, P＝0.047)］.The ROC curve showed that lactate level could predict the mortality of pediatric patients with moderate to severe TBI (AUC=0.949,95%CI: 0.889 to 0.982, P< 0.001). The corresponding sensitivity and specificity of lactic acid cut-off value of 2.5 mmol·L-1 were 88.2% and 90.2%, respectively. Multivariate logistic regression analysis showed that lactic acid level (OR = 1.579,95%CI:1.129 to 2.209)and hypotension within 3 hours after admission (OR=21.658; 95%CI: 2.673 to 175.480)were the independent risk factors of death in moderate to severe TBI. However, GCS≤8 on admission, other organ injury and plasma potassium level on admission were not the independent risk factors for death in this study.Conclusion The level of admission lactate can predict the death of children with moderate to severe TBI. The elevated admission lactate is also an independent risk factor for the mortality of children with moderate to severe TBI.