Post hospital admission blood lactate measurements are associated with mortality but not neurologic morbidity in children with cerebral malaria

Ronke Olowojesiku; Meredith G Sherman; Amina M Mukadam; Rami Imam; Kennedy M Chastang; Karl B Seydel; Alice M Liomba; John R Barber; Nicole F O'Brien; Douglas G Postels

doi:10.1186/s12936-024-04843-z

Post hospital admission blood lactate measurements are associated with mortality but not neurologic morbidity in children with cerebral malaria

Malar J. 2024 Jan 19;23(1):28. doi: 10.1186/s12936-024-04843-z.

Authors

Ronke Olowojesiku¹, Meredith G Sherman², Amina M Mukadam³, Rami Imam⁴, Kennedy M Chastang⁵, Karl B Seydel^{6

7}, Alice M Liomba⁷, John R Barber⁸, Nicole F O'Brien^{7

9}, Douglas G Postels^{10

11}

Affiliations

¹ Department of Pediatrics, Children's National Hospital, Washington, DC, USA.
² Global Health Initiative, Children's National Hospital, Washington, DC, USA.
³ University of Washington, Seattle, WA, USA.
⁴ The George Washington University School of Medicine, Washington, DC, USA.
⁵ Howard University, Washington, DC, USA.
⁶ Michigan State University, East Lansing, MI, USA.
⁷ Kamuzu University of Health Sciences, Blantyre Malaria Project, Blantyre, Malawi.
⁸ Division of Biostatistics and Study Methodology, Children's National Research Institute, Washington, DC, USA.
⁹ Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
¹⁰ Kamuzu University of Health Sciences, Blantyre Malaria Project, Blantyre, Malawi. dpostels@childrensnational.org.
¹¹ Division of Neurology, George Washington University/Children's National Hospital, Washington, DC, USA. dpostels@childrensnational.org.

Abstract

Background: In children with cerebral malaria (CM) admission blood lactate has previously guided intravenous fluid therapy and been validated as a prognostic biomarker associated with death. The usefulness of post-admission measurements of blood lactate in children with CM is less clear. The strength of association between blood lactate and neurological sequelae in CM survivors, as well as the optimal duration of post-admission measurements of blood lactate to identify children at higher risk of adverse outcomes is unknown.

Methods: A retrospective cohort study of 1674 Malawian children with CM hospitalized from 2000 to 2018 who had blood lactate measurements every 6 h for the first 24 h after admission was performed. The strength of association between admission lactate or values measured at any time point in the first 24 h post-admission and outcomes (mortality and neurological morbidity in survivors) was estimated. The duration of time after admission that lactate remained a valid prognostic biomarker was assessed.

Results: When lactate is analysed as a continuous variable, children with CM who have higher values at admission have a 1.05-fold higher odds (95% CI 0.99-1.11) of death compared to those with lower lactate values. Children with higher blood lactate at 6 h have 1.16-fold higher odds (95% CI 1.09-1.23) of death, compared to those with lower values. If lactate levels are dichotomized into hyperlactataemic (lactate > 5.0 mmol/L) or not, the strength of association between admission lactate and mortality increases (OR = 2.49, 95% CI 1.47-4.22). Blood lactate levels obtained after 18 h post-admission are not associated with outcomes. Similarly, the change in lactate concentrations through time during the first 24 h of hospital admission is not associated with outcomes. Blood lactate during hospitalization is not associated with adverse neurologic outcomes in CM survivors.

Conclusions: In children with CM, blood lactate is associated with death but not neurologic morbidity in survivors. To comprehensively estimate prognosis, blood lactate in children with CM should be assessed at admission and for 18 h afterwards.

Keywords: Africa; Lactate; Malaria; Malawi; Paediatric.

MeSH terms

Biomarkers
Child
Hospitals
Humans
Lactic Acid
Malaria, Cerebral* / complications
Morbidity
Retrospective Studies

Substances

Lactic Acid
Biomarkers