Role of Albumin-corrected Anion Gap and Lactate Clearance in Predicting Mortality in Pediatric Intensive Care Patients

Büşra Gündoğan Uzunay, Alper Köker, Nazan Ülgen Tekerek, Levent Dönmez, Oğuz Dursun

Balkan medical journal 2023 Oct 20

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Identifying mortality risk in critically ill children is central to diagnostic and treatment practices. For this purpose, scoring systems, such as the Pediatric Index of Mortality 3 (PIM 3), have been proposed; however, the role of biochemical markers, such as albumin-corrected anion gap (cAG) and lactate clearance (LC), in predicting mortality in pediatric intensive care unit (PICU) patients is yet to be explored. To evaluate the predictive value of the cAG and LC for mortality in pediatric patients admitted to a PICU. Retrospective single-center cohort study. Clinical and laboratory data from the time of PICU admission were collected, and patients were classified into based on their 0- and 6-hour of admission lactate levels into an LC(+) group (patients with normal or decreasing lactate levels) or an LC(−) group (increasing lactate levels). LC and cAG levels were compared using the Mann-Whitney U test and Student’s t-test, respectively. Additionally, multiple logistic regression analysis was performed to evaluate the effect of LC and cAG on mortality. We included 825 patients in the study; the mortality rate was 8.6%. The absence of LC [adjusted odds ratio (AOR) =4.735; 95% confidence interval (CI): 2.163-10.367; p < 0.001], cAG (AOR =1.064; 95% CI: 1.010-1.122; p = 0.019) and PIM 3 (AOR = 1.871; 95% CI: 1.553-2.254; p < 0.001) were independent risk factors for mortality. Using the receiver operating characteristic curve analysis of PIM 3 as a predictor of mortality, area under the curve values of 0.832 (95% CI: 0.805-0.857; p < 0.001) for the original score and 0.858 for a revised PIM 3 score (based on the β coefficients obtained for cAG and LC; 95% CI 0.832-0.881; p < 0.001) were obtained, which was significantly different (p = 0.027). A cAG value > 18 at the time of PICU admission high lactate levels which do not decrease within 6 hours of hospitalization are associated with an increased risk of mortality. The revised PIM 3 score, which includes cAG and LC, is a better predictor of mortality than the classical PIM 3 score.

Citation

Büşra Gündoğan Uzunay, Alper Köker, Nazan Ülgen Tekerek, Levent Dönmez, Oğuz Dursun. Role of Albumin-corrected Anion Gap and Lactate Clearance in Predicting Mortality in Pediatric Intensive Care Patients Balkan medical journal. 2023 Oct 20;40(6):430-434