https://www.ncbi.nlm.nih.gov/pubmed/31995809 drug-induced liver disease
Pediatr Res. 2020 Jan 29. doi: 10.1038/s41390-020-0783-z. [Epub ahead of print]
Evaluating lactate prognostic value in children suspected of acetaminophen-induced liver failure in Liberia.
Haidar MK1,2, Morton N3, Roederer T4, Mayronne S3, Bawo L5, Kerkula J5, Porten K4, Baud FJ3,6,7,8.

Abstract

BACKGROUND:
The prognostic significance of hyperlactatemia in young children with liver injury suspected to be attributed to repeated supratherapeutic doses of acetaminophen remain understudied.

METHODS:
We conducted a retrospective medical chart review including children aged <5 years admitted with hepatocellular injury. The study was conducted in Bardnesville Junction Hospital operated by Médecins Sans Frontières in Monrovia, Liberia.

RESULTS:
We analyzed 95 children with liver injury in whom a blood lactate measurement on admission was available. Eighty children (84%) were aged <2 years; 49 children (52%) died during hospitalization. The median acetaminophen concentration on admission was 20 mg/L with 60 (70%) children presenting concentrations exceeding 10 mg/L. Median lactate was significantly higher in children who died (10.7 mmol/L; interquartile range (IQR): 8.5-15.7) than those who survived (6.1 mmol/L; IQR: 4.1-8.5), P value < 0.001). The optimal threshold obtained was 7.2 mmol/L with a sensitivity of 84% and specificity 70% (area under curve = 0.80). The previously established thresholds of 3.5 and 4 mmol/L lactate had very low specificity identifying non-survival in children included in this study.

CONCLUSION:
In this setting, young children with ALF possibly attributed to acetaminophen toxicity were unlikely to survive if the venous blood lactate concentration exceeded 7.2 mmol/L.