Serum Lactic Acid: A Predictor of Septic Shock in Childhood Cancers with Febrile Neutropenia in a Tertiary Care Hospital in Bangladesh

Background: Febrile neutropenia (FN) is a common and life-threatening complication in children undergoing treatment for cancer, often leading to septic shock. Early identification of septic shock is critical. Serum lactic acid levels have emerged as a potential biomarker for predicting septic shock. This study aimed to determine the implications of serum lactic acid levels as a predictor of septic shock in childhood cancer patients with febrile neutropenia.

Methods: This cross-sectional study was from June 2023 to July 2024. One hundred pediatric oncology patients with neutropenia who were admitted to the Department of Pediatric Hematology and Oncology at Bangabandhu Sheikh Mujib Medical University (BSMMU) were enrolled in the study. Clinical examinations and laboratory investigations were conducted for all participants, and the relevant information was recorded. Data were analyzed using SPSS 24.0.

Results: Shock patients exhibited significantly higher initial serum lactic acid levels (3.52±0.81 mg/dl) compared to non-shock patients (1.93±0.75 mg/dl). The ROC curve analysis yielded an AUC of 0.934, with a sensitivity of 100.00%, specificity of 81.6%, and a cut-off value of 2.50 mg/dl. The diagnostic performance test demonstrated a PPV of 63.16%, NPV of 100.00%, and overall accuracy of 86.00%.

Conclusion: This study demonstrates the potential utility of serum lactic acid levels as a predictive biomarker for identifying febrile neutropenic patients at risk of developing septic shock within 48 hours. Serum lactic acid level >2.5 mmol/L could be considered as a threshold for early risk stratification.