Clinical significance of lactate clearance in patients with cardiogenic shock: results from the RESCUE registry

Abstract

Background Limited data are available on the clinical significance of lactate clearance (LC) in patients with cardiogenic shock (CS). This study investigated the prognostic role of LC in CS patients. Methods We analyzed data from 628 patients in the RESCUE registry, a multicenter, observational cohort enrolled between January 2014 and December 2018. Univariable logistic regression analysis was performed to determine the prognostic implications of 24 h LC, and then patients were divided into two groups according to the cut-off value of 24 h LC (high lactate clearance [HLC] group vs. low lactate clearance [LLC] group). The primary outcome was in-hospital mortality. We also assessed all-cause mortality at 12 month follow-up and compared the prognostic performance of 24 h LC according to initial serum lactate level. Results In the univariable logistic regression analysis, 24 h LC was associated with in-hospital mortality (odds ratio 0.989, 95% confidence interval [CI] 0.985–0.993, p < 0.001), and the cut-off value for the LC of the study population was 64%. The HLC group (initial 24 h LC ≥ 64%, n = 333) had a significantly lower incidence of in-hospital death than the LLC group (n = 295) (25.5% in the HLC group vs. 42.7% in the LLC group, p < 0.001). During 12 months of follow-up, the cumulative incidence of all-cause death was significantly lower in the HLC group than in the LLC group (33.0% vs. 48.8%; hazard ratio 0.55; 95% CI 0.42–0.70; p < 0.001). In subgroup analysis, 24 h LC predicted in-hospital mortality better in patients with initial serum lactate > 5 mmol/L than in those with serum lactate ≤ 5 mmol/L (c-statistics of initial serum lactate > 5 mmol/L = 0.782 vs. c-statistics of initial serum lactate ≤ 5 mmol/L = 0.660, p = 0.011). Conclusions Higher LC during the early phase of CS was associated with reduced risk of in-hospital and 12 month all-cause mortalities. Patients with LC ≥ 64% during the 24 h after CS onset could expect a favorable prognosis, especially those with an initial serum lactate > 5 mmol/L. Trial registration: RESCUE (REtrospective and prospective observational Study to investigate Clinical oUtcomes and Efficacy of left ventricular assist device for Korean patients with cardiogenic shock), NCT02985008, Registered December 5, 2016—retrospectively and prospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT02985008

The role of cardiac power and lactate clearance as an indicator of resuscitation success among pediatric patients with shock in the intensive care unit of Cipto Mangunkusumo Hospital

“…In this study, lactate clearance was higher with every observation interval, and its highest median was discovered at 24 h post-initial resuscitation. This is similar to the study conducted by Park et al, which stated that lactate clearance was highest in the 24-hour observation period [ 19 ].…”

“…Cardiac power did not correlate with the length of stay; however, higher lactate clearance during the first hour after initial resuscitation was correlated with a shorter length of stay in the hospital (r= -0.362, p = 0.017). Previously, a study by Park et al showed that patients with higher lactate clearance (≥64% in 24 h) had longer stay in the ICU (8.0 (4.0–16.5) days versus 6.0 (2.0–15.0) days, p = 0.002) and hospital (14.0 (8.0–28.0) days versus 11.0 (5.0–27.0) days, p = 0.001) [ 19 ]. However, it might be because of the higher in-hospital mortality rate in patients with lower lactate clearance (25.5% versus 42.7%, p < 0.001).…”

Admission lactate level and the GRACE 2.0 score are independent and additive predictors of 30-day mortality of STEMI patients treated with primary PCI—Results of a real-world registry

“…Attana ´et al described the role of lower lactateclearance in higher mortality of patients with STEMI complicated by cardiogenic shock [16]. Recently, these initial results from 51 patients were confirmed by Park et al analyzing a large, multi-center registry with 628 cardiogenic shock patients [17]. Gjesdal et al found that blood lactate is a predictor of short-term mortality in PCI-treated patients with myocardial infarction complicated by mild to moderate heart failure even in the absence of cardiogenic shock [18].…”

Early Recognition and Risk Stratification in Cardiogenic Shock: Well Begun Is Half Done

“…Additionally, serial lactate measurements are a useful tool in order to estimate a patient’s response to therapy [ 51 ] and prognosis [ 21 ]. Recent studies underline the importance of lactate clearance ( LC ) as a prognostic marker, superior to baseline lactate, since higher LC has been significantly associated with better prognosis [ 52 , 53 ]. Lactate clearance is the reduction in lactate concentrations at two different timepoints and can be measured by calculating the percentage of the exact time difference (Δ t ) between lactate concentration on admission ( L 1) and lactate concentration after initial resuscitation ( L 2) [ 53 ].…”