Secondary analysis of the 2021–2023 Sepsis Epidemiology in Australian and New Zealand Children Observational Dataset: Association Between Presenting Venous Lactate Concentration and 72-Hour Outcomes

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Publication Details

Journal
Pediatric Critical Care Medicine
Published
2026-09-14
DOI
https://doi.org/10.1097/pcc.0000000000004055
Primary Topic
Sepsis Diagnosis and Treatment
Type
article
Field-Weighted Citation Impact
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article

Secondary analysis of the 2021–2023 Sepsis Epidemiology in Australian and New Zealand Children Observational Dataset: Association Between Presenting Venous Lactate Concentration and 72-Hour Outcomes

Elliot Long, Arjun Rao, Tom Rozen, Emma Whyte et al.
Pediatric Critical Care Medicine
Sepsis Diagnosis and Treatment
article

Secondary analysis of the 2021–2023 Sepsis Epidemiology in Australian and New Zealand Children Observational Dataset: Association Between Presenting Venous Lactate Concentration and 72-Hour Outcomes

Elliot Long, Arjun Rao, Tom Rozen, Emma Whyte, Amit Kochar, Sainath Raman, Shane George, Jarrod Cross, Ben Gelbart, Sarah McNab, Franz E. Babl, Marino Festa, Simon Craig, Stuart R. Dalziel, Amanda Williams, Anna Lithgow, Stephen Hearps, Warwick Butt, Natalie Phillips, Meredith L. Borland, Subodh Ganu, James Williams, Eunicia Tan, Shefali Jani
article en

Abstract

OBJECTIVES: In pediatric patients with sepsis, we hypothesized that the initial venous lactate concentration would be associated with subsequent need for extracorporeal life support (ECLS) or death within 72 hours. DESIGN: A planned secondary analysis of data from the multicenter, two-country Sepsis Epidemiology Emergency Departments (SENTINEL) study, collected 2021-2023. SETTING: Acute care hospitals in Australia and New Zealand. PATIENTS: SENTINEL participants were children of 0 to less than 18 years with suspected sepsis admitted to the hospital through 11 emergency departments. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We used the initial venous lactate concentration (sampling within 4 hr of hospital arrival) as an explanatory variable for subsequent need for ECLS or death within 72 hours. In 4806 children, with a median (interquartile range [IQR]) age of 1.9 years (IQR, 0.2-6.7 yr), 2651 children (55.2%) were males, and 33 children (0.7%) received ECLS or died within 72 hours. The best-performing initial lactate concentration associated with ECLS or death within 72 hours was 3.5 mmol/L and was observed in 745 of 4806 children (15.5%), including 24 of 33 children requiring ECLS or who died within 72 hours. As a "diagnostic" test, lactate greater than or equal to 3.5 mmol/L had sensitivity (95% CI) of 72.7% (95% CI, 54.5-86.7%), specificity of 84.9% (95% CI, 83.9-85.9%), and area under the receiver-operating characteristics curve of 0.79 (95% CI, 0.71-0.87) for ECLS or death within 72 hours, which are in the acceptable-to-fair category. That is, a 4-hour lactate concentration greater than or equal to 3.5 mmol/L takes the pre- to posttest probability of ECLS/death from 0.7% to 3.2%. CONCLUSIONS: In this secondary analysis of the 2021-2023 SENTINEL dataset, we have found that at the time children are hospitalized with suspected community-acquired sepsis, an initial venous lactate greater than or equal to 3.5 mmol/L has an acceptable-to-fair association with subsequent need for ECLS, or death, within 72 hours. Clinicians will need to decide whether such testing on its own is useful in decision-making.

Pediatric Critical Care Medicine
Griffith University (AU), The University of Sydney (AU), Royal Children's Hospital (AU), University of Auckland (NZ), The University of Queensland (AU), The University of Melbourne (AU), The University of Western Australia (AU), Gold Coast Hospital (AU), Middlemore Hospital (NZ), Princess Margaret Hospital for Children (AU), Townsville Hospital (AU), Women's and Children's Hospital (AU), Monash Medical Centre (AU), Children's Hospital at Westmead (AU), UNSW Sydney (AU), Auckland District Health Board (NZ), Sydney Children's Hospital (AU), Royal Darwin Hospital (AU), Starship Children's Health (NZ), Murdoch Children's Research Institute (AU), Melbourne Health (AU), Children's Health Queensland Hospital and Health Service (AU), Monash University (AU), The University of Adelaide (AU), James Cook University (AU)
Good health and well-being
Openalex Percentile: Top 10%
Sepsis Diagnosis and Treatment
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