الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
T
his study was conducted in the pediatric intensive care unit, Children’s hospital, Ain Shams University during 2013-2015. It included 30 critically ill pediatric patients with sepsis and septic shock who were diagnosed according to International consensus definitions for pediatric sepsis with exclusion of other causes of hyperlactatemia not related to sepsis and septic shock.50% of them were sepsis and the other 50% were septic shock.
Their age range was 40 days to 9 years (1-108 months) with mean age 16 (±29.3) months. 17 (56.7%) of them were males and 13 (43.3%) were females.
Pneumonia was the most common cause of sepsis and septic shock among studied population (40%), followed by encephalitis (26.7%), gastrointestinal tract infection (20%) and wound infection (13.3%).
PRISM score and predicted mortality were calculated (PRISM score is devised to predict outcome and risk of mortality, hence value of predicted mortality is directly proportional to PRISM score.)
The initial prism score and predicted mortality were higher among the non survivors group of patients, average of 9.48 and 10.79% respectively while in the survivors group average of 6.22 and 3.76% respectively, which shows that PRISM score can be a predictor of mortality along with increased lactate levels.
In this study, 21 (70%) patients didn’t survive (38% of which were diagnosed as sepsis while 62% were diagnosed as septic shock) and 9 (30%) survived (77% of which were diagnosed as sepsis while 22% were diagnosed as septic shock).
Mean lactate among all patients was 32.99±15.01, 35.04±23.10, and 35.01±15.41 at 0, 6 and 12 hours respectively which reflects that hyperlactatemia is an important marker in patients with sepsis and septic shock.
Mean of lactate levels among survivors was 27.6, 23.9 and 30.9 at 0, 6 and 12 hours respectively while it was higher among non survivors with mean values of 35.2, 39.7 and 36.7 at 0, 6 and 12 respectively.
Lactate clearance at 6 hours was negative in 15(53.6%) of patients while positive in 13(46.4%) of them, and at 12 hours it was negative in 12 (60%) of patients while positive in 12 (40) of patients where negative value denotes an increase in lactate value while positive value denotes its decrease in serum. Negative lactate clearance at 6 hours was detected among 13 (65%) of non survivors while only 2 (25%) among survivors. Negative lactate clearance at 12 hours was detected among 12 (57.1%) of non survivors while only 6 (66.7%) among survivors.
Among the sepsis patients 9 were dead, 5 (66.7%) of which had negative lactate clearance at 6 hours while 4 (50%) had positive value. Moreover among the sepsis patients 7 had negative lactate clearance at 6 hours, 5 (66.7%) of which didn’t survive while 2 (33.3%) survived. Among the septic shock patients 12 were dead, 9(100%) of which had negative lactate clearance at 6 hours while 3 (60%) has positive value. Among the septic shock patients 9 had negative clearance, all of them (100%) didn’t survive.
Among the Sepsis patients 8 were dead, 6 (60%) of which had negative lactate clearance at 12 hours while 2 (40%) had positive value. Among the sepsis patients 10 had negative lactate clearance, 6 (60%) didn’t survive while 4 (40%) survived. Among septic shock patients 13 were dead, 6 of them (75%) had negative lactate clearance at 12 hours while 7 (100%) had positive value. Among septic shock patients 8 had negative clearance, 6 (75%) of which didn’t survive while 2(25%) survived. This might be because of the effect of antibiotics given and because of the different factors affecting metabolism after 12 hours of the start of management.