Validation of a Portable Hand-Held Lactate Analyzer for Determination of Blood Lactate in Patients on Antiretroviral Therapy in Uganda

Kiragga, Agnes; Ocama, Ponsiano; Reynolds, Steven J.; Kambugu, Andrew; Ojiambo, Henry; Castelnuovo, Barbara

doi:10.1097/qai.0b013e31817e6391

Cited by 7 publications

(11 citation statements)

References 8 publications

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“…These tests included whole-blood lactate testing, which was performed with a validated handheld monitor that is increasingly being used in SSA. [15][16][17][18] Stark contrasts in population demographics between septic patients in SSA and Europe and North America may also diminish the validity of previously studied severity scoring systems when applied to critically ill patients in SSA. For example, many scoring systems use advanced age as a risk criterion, but the mean age in our study was an alarming 35 years of age compared with an average age of 61 years for septic patients in the United States.…”

Section: Discussionmentioning

confidence: 99%

Aggregate Evaluable Organ Dysfunction Predicts In-Hospital Mortality from Sepsis in Uganda

Ssekitoleko¹,

Pinkerton²,

Muhindo³

et al. 2011

The American Society of Tropical Medicine and Hygiene

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We evaluated the association between severity of sepsis and in-hospital mortality in 150 patients with non-surgical sepsis at a regional referral hospital in Uganda. In-hospital mortality occurred in 5 of 52 (9.6%) patients with sepsis, 24 of 71 (33.8%) patients with severe sepsis, and 16 of 27 (59.3%) patients with septic shock. In the multivariate analysis, the identification of severe sepsis (adjusted hazard ratio [AHR] = 2.9, 95% confidence interval [CI] = 1.0–8.2, P = 0.04), septic shock (AHR = 5.7, 95% CI = 1.6–20.3, P = 0.007), and dysfunction of three or more organs (AHR = 2.9, 95% CI = 1.1–7.3, P = 0.03) increased the risk of in-hospital mortality. Adding aggregate organ dysfunction to the multivariate equation that included the sepsis category statistically significantly improved the model, but the opposite did not. Predictors of mortality were easily measurable and could be used to risk stratify critically ill patients in resource-constrained settings.

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Section: Discussionmentioning

confidence: 99%

Aggregate Evaluable Organ Dysfunction Predicts In-Hospital Mortality from Sepsis in Uganda

Ssekitoleko¹,

Pinkerton²,

Muhindo³

et al. 2011

The American Society of Tropical Medicine and Hygiene

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“…This machine has been demonstrated a valid method for point-ofcare testing of lactate levels. 7 We used a cut-off value of >2.0 mmol/L for lactate and ≥2.3 mmol/L for triglycerides to define abnormal values. 1 if blood lactate level was elevated, the test was repeated after 2 weeks.…”

Section: Measurement Of Blood Lactatementioning

confidence: 99%

Blood Lactate in HIV-infected Children on Antiretroviral Therapy in Rural South Africa

Ramshorst

Struthers²,

McIntyre³

et al. 2014

Pediatric Infectious Disease Journal

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We studied blood lactate levels in 253 South African children on antiretroviral therapy. The prevalence of hyperlactatemia was 68% and severity was mild in most cases (69%). There was no association of symptoms and/or signs with hyperlactatemia. Independent predictors were lipo-dystrophy, time on antiretroviral therapy and baseline CD4 count. Increased awareness of hyperlactatemia in African children on antiretroviral therapy is warranted.

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“…POC devices for CD4 immunologic monitoring [33–35] and toxicity monitoring (e.g., lactate, renal function tests [RFT], liver function tests [LFT]) [36, 37] are currently being evaluated or in the development pipeline. These tools have the potential to change the landscape of clinical care among HIV-infected patients in RLS, but only packaged with proper training and good quality management programs will we be able to realize their utility.…”

Section: Hiv Clinical Monitoringmentioning

confidence: 99%

“…HIV-positive patients on ART, particularly stavudine regimens, are at risk for systemic toxicity, including lactic acidosis, renal and/or kidney function impairment, and even death [32, 36, 37]. Clinical chemistry laboratory service is oftentimes limited to hospitals and ART centers in urban areas, is of questionable quality, and can have long turnaround times for results delivery.…”

Section: Hiv Clinical Monitoringmentioning

confidence: 99%

“…Several POC devices have been evaluated in sub-Saharan Africa and elsewhere for performance and utility. At two clinics in Uganda, the Accutrend Lactate analyzer (Accutrend, Roche Diagnostics, Mannheim, Germany) was accurate, reliable, and cost effective [35–37]. In one study [36], there was good correlation comparing Accutrend to the Cobas Integra 400 plus (Roche) hospital standard method [ R 2 = 0.94, bias = −0.06], demonstrating superb agreement between the POC instrument and the laboratory method.…”

Section: Hiv Clinical Monitoringmentioning

confidence: 99%

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A Quality Management Approach to Implementing Point-of-Care Technologies for HIV Diagnosis and Monitoring in Sub-Saharan Africa

Shott

Galiwango

Reynolds

2012

Journal of Tropical Medicine

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Technology advances in rapid diagnosis and clinical monitoring of human immunodeficiency virus (HIV) infection have been made in recent years, greatly benefiting those at risk of HIV infection, those needing care and treatment, and those on antiretroviral (ART) therapy in sub-Saharan Africa. However, resource-limited, geographically remote, and harsh climate regions lack uniform access to these technologies. HIV rapid diagnostic tests (RDTs) and monitoring tools, such as those for CD4 counts, as well as tests for coinfections, are being developed and have great promise in these settings to aid in patient care. Here we explore the advances in point-of-care (POC) technology in the era where portable devices are bringing the laboratory to the patient. Quality management approaches will be imperative for the successful implementation of POC testing in endemic settings to improve patient care.

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Validation of a Portable Hand-Held Lactate Analyzer for Determination of Blood Lactate in Patients on Antiretroviral Therapy in Uganda

Cited by 7 publications

References 8 publications

Aggregate Evaluable Organ Dysfunction Predicts In-Hospital Mortality from Sepsis in Uganda

Aggregate Evaluable Organ Dysfunction Predicts In-Hospital Mortality from Sepsis in Uganda

Blood Lactate in HIV-infected Children on Antiretroviral Therapy in Rural South Africa

A Quality Management Approach to Implementing Point-of-Care Technologies for HIV Diagnosis and Monitoring in Sub-Saharan Africa

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