Association between admission lactate levels and mortality in patients with acute coronary syndrome

Liang, Dongjie; Zhou, Xiaodong; Xia, Hong; Feng, Xiafei; Shan, Peiren; Xie, Qiangli; Xu, Tiancheng; Cai, Mengxing; Zhou, Jian Zhong; Wang, Songjie; Huang, Weijian

doi:10.1097/mca.0000000000000674

Cited by 15 publications

(13 citation statements)

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“…Ruling out cardiogenic shock, in 766 patients with STEMI and NSTEMI undergoing coronary artery bypass surgery, lactate was a predictor of 30-day and late mortality [ 35 ]. In addition, in a study of 1865 patients with ACS, elevated lactate levels (≥ 1.8 mmol/L) at admission were an independent predictor of 30-day and 180-day all-cause mortality [ 18 ]. Lactate is an important fuel for the stressed heart and is produced by the dehydrogenation of pyruvate, which is synthesized from glycolysis [ 36 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, an increasing number of studies have focused on laboratory testing indicators to predict the prognosis of diseases. Several recent studies have shown that lactate level is an independent prognostic factor that is useful for identifying patients at high risk [ 18 – 21 ]. Our purpose in designing a nomogram incorporating lactate was to provide a tool for the clinical evaluation of patients with ACS undergoing PCI.…”

Section: Introductionmentioning

confidence: 99%

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A prognostic nomogram for long-term major adverse cardiovascular events in patients with acute coronary syndrome after percutaneous coronary intervention

Kong

Chen

Guo

et al. 2021

BMC Cardiovasc Disord

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Background Accurate prediction of major adverse cardiovascular events (MACEs) is very important for the management of acute coronary syndrome (ACS) patients. We aimed to construct an effective prognostic nomogram for individualized risk estimates of MACEs for patients with ACS after percutaneous coronary intervention (PCI). Methods This was a prospective study of patients with ACS after PCI from January 2013 to July 2019 (n = 2465). After removing patients with incomplete clinical information, a total of 1986 patients were randomly divided into evaluation (n = 1324) and validation (n = 662) groups. Predictors included in the nomogram were determined by a multivariate Cox proportional hazards regression model based on the training set. Receiver operating characteristic (ROC) curves and calibration curves were used to assess the discrimination and predictive accuracy of the nomogram, which were then compared with those of the classic models. The clinical utility of the nomogram was assessed by X-tile analysis and Kaplan–Meier curve analysis. Results Independent prognostic factors, including lactate level, age, left anterior descending branch stenosis, right coronary artery stenosis, brain natriuretic peptide level, and left ventricular ejection fraction, were determined and contained in the nomogram. The nomogram achieved good areas under the ROC curve of 0.712–0.762 in the training set and 0.724–0.818 in the validation set and well-fitted calibration curves. In addition, participants could be divided into two risk groups (low and high) according to this model. Conclusions A simple-to-use nomogram incorporating lactate level effectively predicted 6-month, 1-year, and 4-year MACE incidence among patients with ACS after PCI.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A prognostic nomogram for long-term major adverse cardiovascular events in patients with acute coronary syndrome after percutaneous coronary intervention

Kong

Chen

Guo

et al. 2021

BMC Cardiovasc Disord

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“…[34] Besides, in a study of 1,865 patients with ACS, elevated lactate levels (≥ 1.8 mmol/L) at admission were an independent predictor of 30-day and 180-day all-cause mortality. [26] In terms of energy supply for heart,in a normal heart, at rest, β-oxidation of fatty acids provides about 60%-90% of energy while pyruvate produces 10%-40%. [35] Lactate produced by dehydrogenation of pyruvate which synthesized from glycolysis, is also an important fuel for the stressed heart.…”

Section: Discussionmentioning

confidence: 99%

“…Several recent studies have shown in disease states, lactate is independent prognostic factor to be useful for identifying patients at high-risk. [26] The increase of lactate concentration is the secondary cause of anaerobic glycolysis caused by tissue hypoperfusion, hypoxia or both, in addition, stress hyperlactataemia is actually due to increased production of aerobic lactate. [27]Multifactor analysis of a latest study showed that for patients with ACS complicating refractory cardiogenic shock (CS) or refractory cardiac arrest (CA), level of lactate at extracorporeal life support implantation was the only independent predictor of survival.…”

Section: Introductionmentioning

confidence: 99%

A Nomogram Based on Lactate to Predict Major Adverse Cardiovascular Events for Acute Coronary Syndrome after Percutaneous Coronary Intervention

Kong

Chen

Zheng

et al. 2021

Preprint

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Background Accurate prediction of major adverse cardiovascular events (MACE) is very important for the management of acute coronary syndrome (ACS) patients. We aim to develop and validate effective prognostic nomogram for individualized risk estimate of MACE in patients with ACS after percutaneous coronary intervention (PCI). Methods We conducted a prospective assessment of patients with ACS after PCI from January 2013 to July 2019 (n = 1986). Based on the training set, single-factor and multi-factor Cox proportional hazard analysis method was used to determine the results of single-factor and multi-factor Cox proportional hazard analysis. The receiver operating characteristic (ROC) and calibration curve were used to evaluate the prediction accuracy and discriminability, we have compared nomogram with the classical cardiovascular risk scores. In the validation set, X-tile analysis and Kaplan-Meier curve were used to evaluate the value of clinical application. Results Independent prognostic factors included lactate, age, left anterior descending branch (LAD) stenosis ≥ 50%, right coronary artery (RCA) stenosis ≥ 50%, brain natriuretic peptide (BNP), and left ventricular ejection fraction (LVEF). The area under the ROC curve (AUC) of the training group were about 0.712 to 0.762. In the validation set, the nomogram still shows good differentiation (AUC were about 0.724 to 0.818). On the calibration plot, the predicted values of the statistical chart agree well with the actual observed values. In addition, participants can be divided into two different risk groups (low and high) according to the nomogram.

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“…Measurement of the initial lactate level may help in predicting the prognosis of critical illnesses, such as sepsis [7,8] or cardiovascular disease [9]. Prior studies have suggested that the initial lactate level is related to prognosis after trauma [10,11].…”

Section: Introductionmentioning

confidence: 99%

The association between the initial lactate level and need for massive transfusion in severe trauma patients with and without traumatic brain injury

et al. 2019

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The association between the initial lactate level and need for massive transfusion in severe trauma patients with and without traumatic brain injury Background: Exsanguination is a major cause of death in severe trauma patients. The purpose of this study was to analyze the prognostic impact of the initial lactate level for massive transfusion (MT) in severe trauma. We divided patients according to subgroups of traumatic brain injury (TBI) and non-TBI. Methods: This single-institution retrospective study was conducted on patients who were admitted to hospital for severe trauma between January 2016 and December 2017. TBI was defined by a head Abbreviated Injury Scale ≥ 3. Receiver operating characteristic analysis was used to analyze the prognostic impact of the lactate level. Multivariate analyses were performed to evaluate the relationship between the MT and lactate level. The primary outcome was MT. Results: Of the 553 patients, MT was performed in 62 patients (11.2%). The area under the curve (AUC) for the lactate level for predicting MT was 0.779 (95% confidence interval [CI], 0.742 to 0.813). The AUCs for lactate level in the TBI and non-TBI patients were 0.690 (95% CI, 0.627 to 0.747) and 0.842 (95% CI, 0.796 to 0.881), respectively. In multivariate analyses, the lactate level was independently associated with the MT (odds ratio [OR], 1.179; 95% CI, 1.070 to 1.299). The lactate level was independently associated with MT in non-TBI patients (OR, 1.469; 95% CI, 1.262 to 1.710), but not in TBI patients. Conclusions: The initial lactate level may be a possible prognostic factor for MT in severe trauma. In TBI patients, however, the initial lactate level was not suitable for predicting MT.

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Association between admission lactate levels and mortality in patients with acute coronary syndrome

Cited by 15 publications

References 24 publications

A prognostic nomogram for long-term major adverse cardiovascular events in patients with acute coronary syndrome after percutaneous coronary intervention

A prognostic nomogram for long-term major adverse cardiovascular events in patients with acute coronary syndrome after percutaneous coronary intervention

A Nomogram Based on Lactate to Predict Major Adverse Cardiovascular Events for Acute Coronary Syndrome after Percutaneous Coronary Intervention

The association between the initial lactate level and need for massive transfusion in severe trauma patients with and without traumatic brain injury

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Association between admission lactate levels and mortality in patients with acute coronary syndrome

Cited by 15 publications

References 24 publications

A prognostic nomogram for long-term major adverse cardiovascular events in patients with acute coronary syndrome after percutaneous coronary intervention

A prognostic nomogram for long-term major adverse cardiovascular events in patients with acute coronary syndrome after percutaneous coronary intervention

A&nbsp;Nomogram Based on Lactate to Predict&nbsp;Major Adverse Cardiovascular Events for Acute Coronary Syndrome after Percutaneous Coronary Intervention

The association between the initial lactate level and need for massive transfusion in severe trauma patients with and without traumatic brain injury

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A Nomogram Based on Lactate to Predict Major Adverse Cardiovascular Events for Acute Coronary Syndrome after Percutaneous Coronary Intervention