Urinary Lactate as a Predictor of Early Onset Sepsis in Neonates
Objectives: Diagnosing Early-Onset Sepsis (EOS) requires a sensitive, specific, and easily available marker. This study was conducted for the estimation of the cut-off level of urinary and plasma lactate for the diagnosis of EOS.
Study Design: Hundred neonates at risk of early onset sepsis were included. Sepsis screen, blood culture, and plasma lactate within 2 hours and urinary lactate in the first urine sample were done. CRP, plasma and urinary lactate were repeated at 24 ± 2 hours. Receiver-operating characteristic curve was drawn to find the optimal cut-off point of urinary and plasma lactate levels.
Results: Median urinary lactate in the sepsis group were 0.6 mMol/L and 0.40 mMol/L and in the non-sepsis group, they were 0.41 mMol/L and 0.38 mMol/L in the 1st passed sample and at 24 hours respectively. Both urinary and plasma lactate were not able to diagnose early onset sepsis. However, urinary lactate proved to be a useful marker for diagnosing sepsis with shock and mortality.
Conclusion: Our study concludes that although urinary and plasma lactate do not predict EOS, urinary lactate can predict shock and mortality in babies with EOS at 24 hours of life.
How to cite this article:
Bhat RR, Batra P, Harit D, Banerjee B, Kotru M, Sharma T, Chillar N. Urinary Lactate as a Predictor of Early Onset Sepsis in Neonates. Postgrad J Pediatr Adol Med. 2022;1(2):10-15.
Puopolo KM. Bacterial and fungal infections. In: Eichenwald EC, Hansen AR, Martin CR, Stark AR, editors. Manual of neonatal care. 8th ed. Philadelphia: Wolters Kluwer. 2017;684.
Agarwal R, Deorari A, Paul V, Sankar MJ, Sachdeva A, editors. Neonatal sepsis. AIIMS protocols in neonatology. 2nd ed. New Delhi: CBS Publishers 2019. 303 p.
Choudhury J, Routray SS, Dash LD. Effectiveness of predicting outcome in septic shock in critically ill children by assessing serum lactate levels. Pediatr RevInt J Pediatr Res. 2016;3:9-12.
Reed L, Carroll J, Cummings A, Markwell S, Wall J, Duong M. Serum lactate as a screening tool and predictor of outcome in pediatric patients presenting to the emergency department with suspected infection. Pediatr Emerg Care. 2013;29(7):787-91. [PubMed] [Google Scholar]
Oh W, Perritt R, Shankaran S, Merritts M, Donovan EF, Ehrenkranz RA, O’Shea TM, Tyson JE, Laptook AR, Das A, Higgins RD. Association between urinary lactate to creatinine ratio and neurodevelopmental outcome in term infants with hypoxic-ischemic encephalopathy. J Pediatr. 2008;153:375-8. [PubMed] [Google Scholar]
Fanos V, Pintus MC, Lussu M, Atzori L, Noto A, Stronati M, Guimaraes H, Marcialis MA, Rocha G, Moretti C, Papoff P, Lacerenza S, Puddu S, Giuffre M, Serraino F, Mussap M, Corsello G. Urinary metabolomics of Bronchopulmonary Dysplasia (BPD): preliminary data at birth suggest it is a congenital disease. J Matern Fetal Neonatal Med. 2014;27(Suppl 2):39-45. [PubMed] [Google Scholar]
Dutta S, Sandeep Kadam S, Saini SS, editors. Management of neonatal sepsis. NNF clinical based guidelines. New Delhi. 2010;155.
Haque KN. Definitions of bloodstream infection in the newborn. Pediatr Crit Care Med. 2005;6:S45-9. [PubMed] [Google Scholar]
Dia Sys [Internet]. Multi-purpose kits lactate FS; [cited 2019;26]. Available from: https://www.diasysdiagnostics.com/products/kit-lines/multi-purpose-kits/product-details/200-lactate-fs/product.show
Vary TC. Sepsis-induced alterations in pyruvate dehydrogenase complex activity in rat skeletal muscle: effects on plasma lactate. Shock. 1996;6:89-94. [PubMed] [Google Scholar]
Astiz ME, Rackow EC, Falk JL, Kaufman BS, Weil MH. Oxygen delivery and consumption in patients with hyperdynamic septic shock. Crit Care Med. 1987;15(1):26-8. [PubMed] [Google Scholar]
Friedman G, De Backer D, Shahla M, Vincent JL. Oxygen supply dependency can characterize septic shock. Intensive Care Med. 1998;24:118-23. [PubMed] [Google Scholar]
Huckabee WE. Abnormal resting blood lactate. I. The significance of hyperlactatemia in hospitalized patients. Am JMed. 1961;30(6):840-8. [PubMed] [Google Scholar]
Kreymann G, Grosser S, Buggisch P, Gottschall C, Matthaei S, Greten H. Oxygen consumption and resting metabolic rate in sepsis, sepsis syndrome, and septic shock. Crit Care Med. 1993;21:1012-9. [PubMed] [Google Scholar]
McCarter FD, Nierman SR, James JH, Wang L, King JK, Friend LA, Fischer JE. Role of skeletal muscle Na+ −K+ ATPase activity in increased lactate production in subacute sepsis. Life Sci. 2002;70(16):1875-88. [PubMed] [Google Scholar]
BundgaardH, Kjeldsen K, Krabbe KS, van Hall G, Simonsen L, Qvist J, Hansen CM, Moller K, Fonsmark L, Madsen PL, Pedersen BK. Endotoxemia stimulates skeletal muscle Na+‐K+‐ATPase and raises blood lactate under aerobic conditions in humans. Am J Physiol Heart Circ Physiol. 2003;284:H1028-34. [PubMed][Google Scholar]
Levy B, Desebbe O, Montemont C, Gibot S. Increased aerobic glycolysis through beta 2 stimulation is a common mechanism involved in lactate formation during shock states. Shock. 2008;30(4):417-21. [PubMed] [Google Scholar]
James JH, Fang CH, Schrantz SJ, Hasselgren PO, Paul RJ, Fischer JE. Linkage of aerobic glycolysis to sodium-potassium transport in rat skeletal muscle. Implications for increased muscle lactate production in sepsis. J Clin Invest. 1996;98:2388-97. [PubMed] [Google Scholar]
Hawdon JM, Ward Platt MP, Aynsley-Green A. Patterns of metabolic adaptation for preterm and term infants in the first neonatal week. Arch Dis Child. 1992;67:357-65. [PubMed] [Google Scholar]
Gustafsson J. Neonatal energy substrate production. Indian J Med Res. 2009;130:618-23. [PubMed] [Google Scholar]
Levraut J, Ciebiera JP, Chave S, Rabary O, Jambou P, Carles M, Grimaud D. Mild hyperlactatemiain stable septic patients is due to impaired lactate clearance rather than overproduction. Am J Respir Crit Care Med. 1998;157:1021-6. [PubMed] [Google Scholar]
Bellomo R, Ronco C. The pathogenesis of lactic acidosis in sepsis. Curr Opin Crit Care. 1999;5:452-7. [Google Scholar]
Barrie P, Tom PJ. Lactate physiology in health and disease. Conti Educ Anesth Crit Care Pain. 2006;6:128-32. [Google Scholar]
Bellomo R. Bench‐to‐bedside review: lactate and the kidney. Crit Care. 2002;6(4):322-6. [PubMed] [Google Scholar]
Farkas J [Internet]. Understanding lactate in sepsis &using it to our advantage. PulmCrit; 2015 [cited 2019;26]. Available from: https://emcrit.org/pulmcrit/understanding-lactate-in-sepsis-using-it-to-ouradvantage