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Validity of Peripheral Venous Lactate as a Biomarker for Severe Manifestation of Dengue in Adults FREE TO VIEW

Nittha Oer-Areemitr; Vipa Thanachartwet; Varunee Desakorn; Akanitt Jittmittraphap; Duangjai Sahassananda; Anan Wattanathum
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Phramongkutklao Hospital, Bangkok, Thailand

Chest. 2015;148(4_MeetingAbstracts):341A. doi:10.1378/chest.2277740
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SESSION TITLE: Sepsis and Shock Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: to determeine the validity of peripheral venous lactate as a tool to identify severe plasma leakage in adult with dengue

METHODS: this study was conducted as a prospective diagnostic study among adults with dengue, who admitted to the hospital of tropical diseases during 2012-2014. Baseline demographics, clinical findings, routine laboratory parameters, peripheral venous lactate and confirmation of dengue viral infection were recorded in a pre-defined case report form. Severe manifestation of dengue was defined as severe plasma leakage with shock and or respiratory distress as in WHO 2009 classification. The data were retrieved and analyzed; a receiver operating characteristic (ROC) curve was used to determine the optimal cutoff value.

RESULTS: A total of 153 patients with confirmed dengue, 16 (10.5%) patients had severe plasma leakage during hospitalization. Based on peripheral venous lactate on admission, a ROC curve analysis demonstrated an area under the curve (AUC) of 0 0.83 (95% CI = 0.68-0.98) for identifying severe plasma leakage. The sensitivity and specificity of peripheral venous lactate at 2.5 mmol/L were 75.0% (95% CI = 47.6-92.6) and 94.9% (95% CI = 89.8-97.9), respectively. In order to improve the diagnostic value of lactate at the level of 2.5 mmol/L, the lactate on admission and repeated lactate within 24 hours were combined. The result showed that the sensitivity was 87.5% (95% CI =61.6-98.1) and the specificity was 91.4% (95% CI =84.4-96.0). When peripheral venous lactate on day 4 of fever or after were evaluated, a ROC curve analysis demonstrated an AUC of 0.92 (95% CI = 0.84-1.00). The sensitivity and specificity of peripheral venous lactate at the optimal cutoff value of 2.5 mmol/L to identify severe plasma leakage were 81.3% (95% CI = 54.3-95.7) and 92.0% (95% CI = 86.1-95.9), respectively.

CONCLUSIONS: Pheripheral venous lactate on admission with repeated lactate within 24 hours or peripheral venous lactate on day 4 of fever and beyond, at a cutoff value of 2.5 mmol/L, could be used as a valid tool for identifying severe manifestation of dengue in adults.

CLINICAL IMPLICATIONS: Peripheral venous lactate not only can be used for identifying severe plasma leakage in adults dengue, but also can be used as a tool to decrease unnecessary hospitalization of dengue infection. At present, the hospital burden is increasing due to we use WHO 2009 warning signs as an indication for admission. Therefore, using lactate might help to decrease hospital burden of dengue in the future.

DISCLOSURE: The following authors have nothing to disclose: Nittha Oer-Areemitr, Vipa Thanachartwet, Varunee Desakorn, Akanitt Jittmittraphap, Duangjai Sahassananda, Anan Wattanathum

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