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 (L:P) 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 L:P ≥ 25 correlated with biochemical variables of clinical severity; and to determine whether lactate or L:P 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 L:P were similar among the 3 etiologic groups. There was no significant association between the initial lactate or L:P and biochemical variables of clinical severity or clinical outcome at 21 days.

Conclusions: A serum lactate ≥ 2.5 mmol/L and/or elevated L:P 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.

Keywords: biomarker; liver transplant; mitochondrial liver disease.

Conflict of interest statement

Conflicts of Interest: None of the authors have any conflicts of interest to disclose

Copyright © 2016 Elsevier Inc. All rights reserved.

Figures

Figure 1

(online only): Flowchart of Lactate and Pyruvate Availability in all PALF Subject

Figure 2

Distribution of blood lactate levels, pyruvate levels, and lactate: pyruvate molar ratios of PALF participants (n=110)

Figure 3

Lactate to Pyruvate (L:P) Molar Ratio Relationship to Serum Lactate or Pyruvate Levels by Diagnostic Group (n=110)