Lactate and Lactate: Pyruvate Ratio in the Diagnosis and Outcomes of Pediatric Acute Liver Failure.

ABSTRACT

OBJECTIVES: To assess the accuracy of blood lactate and lactate pyruvate molar ratio (LP) as a screen for mitochondrial, respiratory chain, or fatty acid oxidation disorders in children with pediatric acute liver failure (PALF); to determine whether serum lactate ≥ 2.5 mmol/L or LP ≥ 25 correlated with biochemical variables of clinical severity; and to determine whether lactate or LP is associated with clinical outcome at 21 days. STUDY DESIGN: Retrospective review of demographic, clinical, laboratory, and outcome data for PALF study group participants who had lactate and pyruvate levels collected on the same day. RESULTS: Of 986 participants, 110 had lactate and pyruvate levels collected on the same day. Of the 110, the etiology of PALF was a mitochondrial disorder in 8 (7%), indeterminate in 65 (59%), and an alternative diagnosis in 37 (34%). Lactate, pyruvate, and LP were similar among the 3 etiologic groups. There was no significant association between the initial lactate or LP and biochemical variables of clinical severity or clinical outcome at 21 days. CONCLUSIONS: A serum lactate ≥ 2.5 mmol/L and/or elevated LP was common in all causes of PALF, not limited to those with a mitochondrial etiology, and did not predict 21-day clinical outcome. TRIAL REGISTRATION ClinicalTrials.gov NCT00986648.