Paediatrica Indonesiana (Aug 2007)

Comparison of serial blood lactate level between dengue shock syndrome and dengue hemorrhagic fever (evaluation of prognostic value)

  • M. Tatang Puspanjono,
  • Abdul Latief,
  • Alan R. Tumbelaka,
  • Sudigdo Sastroasmoro,
  • Hartono Gunardi

DOI
https://doi.org/10.14238/pi47.4.2007.150-5
Journal volume & issue
Vol. 47, no. 4
pp. 150 – 5

Abstract

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Background Dengue shock syndrome (DSS) mortality is still high. Monitoring of blood lactate level is important to evaluate shock. Objectives The study were to review the difference between blood lactate level of DSS and that of dengue hemorrhagic fever (DHF), to correlate blood lactate level with hypoxia state as shock risk factors (PaO 2 , oxygen saturation, and anion gap) and to determine the cut-off point of blood lactate level to predict shock. Methods The study was carried out at the Department of Child Health, Medical School, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, from January until July 2006. Three mL venous blood specimen was collected from all subjects for peripheral blood, blood gasses, serology, and blood lactate examinations. This study consisted of a retrospective cohort and a cross sectional method. Data were analyzed with Chi-square test. Continous data tested using Mann-Whitney method. To know the correlation between blood lactate level and shock risk factors we use logistic regression test. Results In DSS group, 73% shows hyperlactatemia (lactate =2 mmol/L). Conversion of lactate means between two groups is significantly different from day one to day two and three. There was a negative correlation between lactate level and pO 2 and oxygen saturation. Oxygen saturation is the only value that has clinical correlation. Regressions analysis can be applied using Y = 7.05–0.05 X equation. The cut-off point of lactate level as marker for shock by using ROC curve is 32.015 mmol/L with 70% sensitivity and 83.3% specificity. Conclusions Hyperlactatemia in DSS can be considered as a sign for unappropriate treatment of shock. Blood lactate level can be used as a biochemical marker for tissue hypoxia, to assess severity of the disease, as monitoring of treatment, and has prognostic value of DHF cases.

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