Abstract O-57: LACTATE CLEARANCE AS A PROGNOSTIC MARKER OF MORTALITY IN SEVERELY ILL FEBRILE CHILDREN IN EAST AFRICA

Aims & Objectives: Hyperlactataemia(HL) is a biomarker of disease severity that predicts mortality in patients with sepsis and malaria. Lactate clearance(LC) is a prognostic factor of survival in septic critically-ill adults. Little data exist in children living in malaria-endemic areas. Our main aim was to assess the prognostic value of LC at 8hrs on mortality at 72 hours(d72) in a large cohort of severely ill febrile children in an endemic-malaria area. Methods In a secondary data analysis of a fluid resuscitation trial(FEAST), we assessed the association between lactate levels at admission and LC at 8hrs with d72. LC was defined as a relative lactate decline ≥40% and/or lactate normalisation(<2.5 mmol/L). Results 3008/3170 (95%) children had a baseline lactate measurement, 2127 (71%) had HL (lactate ≥2.5 mmol/L), and 1179 (39%) had severe HL (≥5 mmol/L). Within 72 hours 309 (10.3%) children died; 284 (92%) had baseline HL. After adjustment for potential confounders, severe HL was strongly associated with mortality (OR=6.96; 95%CI 3.52–13.76). This association was not modified by malaria status. At 8 hours, 2748 (91%) survivors had a lactate measured; 1906 (63%) of whom had HL on admission.1014 (53%) fulfilled pre-defined LC criteria. After adjustment for confounders, LC at 8hrs strongly predicted survival (OR 0.24; 95%CI 0.14–0.42). Conclusions HL is a strong risk factor for d72 in children with severe febrile illnesses in Africa. LC within 8hrs predicts an improved chance of survival. These findings prompt the more widespread use of lactate and LC to identify children with severe disease and monitor response to treatment.