Association between serum lactate levels and mortality in patients with cardiogenic shock receiving mechanical circulatory support: a multicenter retrospective cohort study

Abstract

Background: To evaluate the prognostic value of peak serum lactate and lactate clearance at several time points in cardiogenic shock treated with temporary mechanical circulatory support (MCS) using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) or Impella CP®.Methods: Serum lactate and clearance were measured before MCS and at 1h, 6h, 12h, and 24h post-MCS in 43 patients at four tertiary-care centers in Southern Brazil. Prognostic value was assessed by univariable and multivariable analysis and receiver operating characteristic (ROC) curves for 30-day mortality.Results: VA-ECMO was the most common MCS modality (58%). Serum lactate levels at all time points and lactate clearance after 6h were associated with mortality on unadjusted and adjusted analyses. Lactate levels were higher in non-survivors at 6h, 12h, and 24h after MCS. Serum lactate > 1.55 mmol/L at 24h was the best single prognostic marker of 30-day mortality [area under the ROC curve = 0.81 (0.67-0.94); positive predictive value = 86%). Failure to improve serum lactate after 24h was associated with 100% mortality.Conclusions: Serum lactate was an important prognostic biomarker in cardiogenic shock treated with temporary MCS. Serum lactate and lactate clearance at 24h were the strongest independent predictors of short-term survival.

Changes in Sequential Organ Failure Assessment sub-scores as predictors of mortality in patients with septic acute kidney injury requiring continuous renal replacement therapy

“…In the present study, lactate levels more significantly appeared to be associated with mortality in patients without sepsis. Elevated lactate levels reflect peripheral circulation failure and systemic inflammation with vascular endothelial damage 30 , thus offering an independent predictor of mortality in patients with sepsis 5, 31 and patients with cardiac shock 32 . A decrease in systolic and diastolic blood pressures is reportedly predicted for in-hospital mortality after CRRT in a study of critically ill patients 33 .…”

Efficacy and safety of ECG‐synchronized pulsatile extracorporeal membrane oxygenation in the clinical setting: The SynCor Trial

“…In their retrospective analysis of fifteen patients with CS, two‐thirds of the patients had undergone cardiopulmonary resuscitation and the mean serum lactate at inclusion was 6.7 mmol/L. In two observational studies of patients in CS treated with MCS, both serum lactate levels and lactate clearance were associated with 30‐day mortality 19,20 . According to a recent article, analyzing data from a CS registry, baseline serum lactate greater than 4.0 mmol/L was associated with a sevenfold increase in mortality.…”

“…In two observational studies of patients in CS treated with MCS, both serum lactate levels and lactate clearance were associated with 30-day mortality. 19,20 According to a recent article, analyzing data from a CS registry, baseline serum lactate greater than 4.0 mmol/L was associated with a sevenfold increase in mortality. These results prompted the authors to recommend this threshold as indication for MCS.…”