Prognostic Value of Lactate Clearance in Critically Ill Pediatric Patients Admitted to the Intensive Care Unit: A Single-Center Study from Southern Iran

Background: Lactate clearance is considered a reliable indicator of tissue perfusion and treatment response in critically ill patients. However, its prognostic significance in pediatric intensive care units has not been adequately defined. This study aims to investigate the prognostic value of lactate clearance in pediatric patients admitted to the intensive care unit of Bandar Abbas Children’s Hospital, Iran. Method: In this prospective cross-sectional study, critically ill children aged 1 month to 17 years admitted to the pediatric intensive care unit of Bandar Abbas Children’s Hospital, Iran, were consecutively enrolled. Arterial lactate levels were obtained at admission and at 6 and 24 hours, and lactate clearance was calculated. Clinical outcomes (survival or death) were recorded. Receiver operating characteristic curve analysis was performed to evaluate the prognostic performance of lactate clearance. The chi-square test and analysis of variance (ANOVA) were used, and a p-value < 0.05 was considered statistically significant. Result: A total of 169 children admitted to the pediatric intensive care unit were included, of whom 54 (31.9%) died; 59.3% were male, and the mean age was 7.56±1.03 years. Admission lactate clearance was not a reliable predictor of clinical outcome (P=0.064). In contrast, lactate clearance at 6 and 24 hours demonstrated high sensitivity for outcome prediction (97.39% and 94.78%, respectively). Comparative analysis showed that 24-hour lactate clearance, with a cut-off value of 48.7, exhibited superior prognostic performance. Conclusion: Twenty-four-hour lactate clearance appears to be a useful prognostic indicator in critically ill pediatric patients admitted to the PICU. Lactate monitoring allows for a more accurate assessment of treatment response and improved risk stratification.