Admission Lactate Shows the Highest Observed Discrimination for Early Septic Shock in Pediatric Sepsis: A Retrospective Cohort Study
| Author | Thi Van Vo | en |
| Author | Trinh Van Nguyen | en |
| Author | Nguyen Phat Nguyen | en |
| Author | Huy Quoc Tran | en |
| Author | Dien Minh Thai | en |
| Orcid | Thi Van Vo [0009-0008-8377-0217] | en |
| Orcid | Trinh Van Nguyen [0009-0003-8195-2870] | en |
| Orcid | Nguyen Phat Nguyen [0009-0007-6715-0715] | en |
| Orcid | Huy Quoc Tran [0009-0004-6391-4018] | en |
| Orcid | Dien Minh Thai [0009-0000-7007-8485] | en |
| Issued Date | 2026-11-30 | en |
| Abstract | Context: Early discrimination of septic shock in children with sepsis remains challenging, and the comparative value of routinely available pretreatment biomarkers is uncertain. This study aimed to compare admission white blood cell count, C-reactive protein, procalcitonin (PCT, modeled as ln(PCT)), and lactate for early discrimination of septic shock in children with sepsis. Evidence Acquisition: We retrospectively studied children aged 2 months to 15 years who were admitted to a tertiary referral pediatric intensive care unit between July 2022 and July 2025. Biomarkers were defined as the earliest pretreatment measurements obtained at admission or within 6 hours. Early septic shock was operationally defined as the initiation of continuous vasoactive/inotropic support for sepsis-associated cardiovascular dysfunction within 24 hours. Discrimination was assessed using receiver operating characteristic analysis, and associations were examined using multivariable logistic regression. Results: Among 193 children, 93 (48.2%) met the operational definition of early shock. Lactate and PCT levels were higher in the early-shock group (both P < 0.001), whereas WBC and CRP levels were not. Lactate had the highest observed area under the receiver operating characteristic curve, at 0.77 (95% confidence interval [CI], 0.70 - 0.85), followed by PCT (0.71; 95% CI, 0.63 - 0.79). At the exploratory cohort-derived lactate cutoff of 4.17 mmol/L, sensitivity was 64.4% and specificity was 80.0%. In the complete-biomarker cohort, lactate was not statistically superior to PCT by paired DeLong testing (0.782 vs. 0.708; P = 0.197). In the primary parsimonious multivariable model, lactate (odds ratio [OR], 1.34 per 1-mmol/L increase; 95% CI, 1.14 - 1.58; P < 0.001) and natural logarithm-transformed PCT (OR, 1.25; 95% CI, 1.04 - 1.50; P = 0.019) were associated with early shock. In the expanded exploratory model, lactate remained associated (OR, 1.41; 95% CI, 1.17 - 1.70; P < 0.001), whereas the association with ln(PCT) was attenuated (P = 0.057). Conclusions: Admission lactate demonstrated the highest observed discrimination and may complement early clinical and hemodynamic assessments. The cohort-derived thresholds are exploratory and require external validation. | en |
| DOI | https://doi.org/10.5812/jcp-173635 | en |
| URI | https://brieflands.com/journals/jcp/articles/173635 | en |
| Keyword | Lactic Acid | en |
| Keyword | Procalcitonin | en |
| Keyword | Sepsis | en |
| Keyword | Shock | en |
| Keyword | Biomarkers | en |
| Keyword | Pediatrics | en |
| Publisher | Brieflands | en |
| Title | Admission Lactate Shows the Highest Observed Discrimination for Early Septic Shock in Pediatric Sepsis: A Retrospective Cohort Study | en |
| Type | Review Article | en |
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