Lactate Clearance as a Surrogate for Mortality in Cardiogenic Shock: Insights From the DOREMI Trial

Marbach, Jeffrey A.; Santo, Pietro Di; Kapur, Navin K.; Thayer, Katherine; Simard, Trevor; Jung, Richard G.; Parlow, Simon; Abdel‐Razek, Omar; Fernando, Shannon M.; Labinaz, Marino; Froeschl, Michael; Mathew, Rebecca; Hibbert, Benjamin

doi:10.1161/jaha.121.023322

Cited by 30 publications

(18 citation statements)

References 30 publications

(33 reference statements)

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“…A recent meta-analysis found that, among an allcomers CS cohort, survivors had significantly greater lactate clearance at 6–8 and 24-h compared to nonsurvivors [25]. Similar results were found in a substudy of the DOREMI trial, where there was a greater rate of lactate normalization among survivors than nonsurvivors at all timepoints, including as early as 4-h from randomization [26 ▪▪ ].…”

Section: Laboratory Parameterssupporting

confidence: 52%

Outcomes in cardiogenic shock: the role of surrogate endpoints

Kosyakovsky

Marbach

Nguyen

et al. 2022

Current Opinion in Critical Care

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Purpose of reviewEarly revascularization, invasive hemodynamic profiling, and initiation of temporary mechanical circulatory support (MCS) have all become routine components of cardiogenic shock (CS) management. Despite this evolution in clinical practice, patient selection and timing of treatment initiation remain a significant barrier to achieving sustained improvement in CS outcomes. Recent efforts to standardize CS management, through the development of treatment algorithms, have relied heavily on surrogate endpoints to drive therapeutic decisions. The present review aims to provide an overview of the basis of evidence for those surrogate endpoints commonly employed in clinical trials and CS management algorithms.Recent findingsRecent publications from both observational and randomized cohorts have demonstrated the utility of surrogate endpoints in risk stratifying patients with CS. In particular, invasive hemodynamics using pulmonary artery catheters to guide initiation and weaning of MCS, biochemical markers that portend imminent end-organ failure, and clinical risk scores that combine multiple hemodynamic and laboratory parameters have demonstrated an ability to prognosticate outcomes in patients with CS.SummaryAlthough further validation is necessary, multiple clinical, hemodynamic, and biochemical markers have demonstrated utility as surrogate endpoints in CS, and will undoubtedly assist physicians in clinical decision-making.

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Section: Laboratory Parameterssupporting

confidence: 52%

Outcomes in cardiogenic shock: the role of surrogate endpoints

Kosyakovsky

Marbach

Nguyen

et al. 2022

Current Opinion in Critical Care

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“…The systemic review of 12 studies analyzing the association between lactate clearance and outcomes in patients with CS showed that survivors had 17.3% higher level of lactate clearance at 6–8 h ( p < 0.001) and 27.9% higher level of lactate clearance at 24 h ( p < 0.001) compared to non-survivors [ 39 ]. In a randomized, double-blind, controlled DOREMI (Dobutamine Compared to Milrinone in the Treatment of Cardiogenic Shock) prospective trial, lactate clearance was a significant survival predictor at all time points, with OR between 2.46 at 8 h (95% CI 1.09–5.55; p = 0.03) to 5.44 at 24 h (95% CI 2.14–13.8; p < 0.01) [ 40 ]. The possible pathologic mechanisms of the above mentioned association was investigated in the recent Cardiac Magnetic Resonance Imaging Study in 360 patients with AMI undergoing PCI, where the levels of admission lactate above 2.5 mmol/L showed a higher association with a larger size of myocardial injury (OR 1.59; 95% CI 1.00–2.51; p = 0.048) [ 41 ].…”

Section: Resultsmentioning

confidence: 99%

Laboratory Predictors of Prognosis in Cardiogenic Shock Complicating Acute Myocardial Infarction

Muzafarova

Motovska

2022

Biomedicines

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Cardiogenic shock is a state of reduced cardiac output leading to hypotension, pulmonary congestion, and hypoperfusion of tissues and vital organs. Despite the advances in intensive care over the last years, the morbidity and mortality of patients remain high. The available studies of patients with cardiogenic shock suggest a connection between clinical variables, the level of biomarkers, the results of imaging investigations, strategies of management and the outcome of this group of patients. The management of patients with cardiogenic shock initially complicating acute myocardial infarction is challenging, and the number of studies in this area is growing fast. The purpose of this review is to summarize the currently available evidence on cardiogenic shock initially complicating acute myocardial infarction with particular attention to predictors of prognosis, focusing on laboratory variables (established and new), and to discuss the practical implementation. Currently available scoring systems developed during the past few decades predict the clinical outcome of this group of patients using some of the established biomarkers among other variables. With the new laboratory biomarkers that have shown their predictive value in cardiogenic shock outcomes, a new design of scoring systems would be of interest. Identifying high-risk patients offers the opportunity for early decision-making.

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“…Secondly, most monitoring tools are indirectly re ecting the status of microcirculation (e.g. the Mottling score [5,25], skin temperature [26], central-to-toe temperature difference [4,26], lactate and lactate clearance [27], peripheral perfusion index [28], etc.). Thirdly, the accuracy remains to be proven.…”

Section: Discussionmentioning

confidence: 99%

Association of sublingual microcirculation parameters and capillary refill time in the early phase of ICU admission

Huang

Xiang

et al. 2022

Preprint

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Background: Recent studies demonstrate the advantage of peripheral perfusion-targeted resuscitation protocols based on capillary refill time (CRT) assessment in critically ill patients. Additionally, sidestream dark field (SDF) imaging could direct visualize sublingual microcirculation of critically ill patients. This study aimed to determine the association between the sublingual microcirculation and CRT in critically ill patients in the early phase of intensive care unit (ICU) admission. Methods: This prospective, observational, pilot study included 282 patients in the ICU of Zhongnan Hospital of Wuhan University between October 2021 and January 2022. All patients underwent simultaneous measurements by CRT and SDF imaging within 24 hours of ICU admission. Additionally, other clinical data such as demographic variables, hemodynamics, laboratory values, treatment, and physiological parameters were also included. The primary outcome was the association between CRT and simultaneous sublingual microcirculation parameters in critically ill patients.Results: Of the 282 included patients, 106 (37.6%) were female, the median (IQR) age was 63 (53-74) years, and the median (IQR) SOFA score was 5 (2-7). Microcirculatory measurements (CRT and SDF imaging) were performed at 10.2 ± 5.7 hours after ICU admission. Significant relationships were observed between the CRT and MFI (r = -0.4430, p < 0.001), PPV (r = -0.3708, p < 0.001), PVD (r = -0.1835, p = 0.0020), and HI (r = 0.4378, p < 0.001). Neither TVD (p = 0.9641) nor De Backer score (p = 0.5202) were related to the CRT. Compare to CRT< 3s group, MFI (2.60 vs. 2.88, p < 0.001), PPV (91.35% vs. 99.10%, p < 0.001), PVD (13.36 mm/mm2 vs. 14.55 mm/mm2, p = 0.002), and HI (0.46 vs. 0.15, p < 0.001) were significantly worse in the CRT ≥ 3s group. The similar results were also found in the sepsis subgroup and the hyperlactatemia subgroup. Prolonged CRT was an independent predictor of 28-days mortality (OR = 1.296; (95%CI, 1.078-1.558); p = 0.006).Conclusions: Our findings suggested that there was a significant and moderate association between CRT and some sublingual microcirculation parameters more related to perfusion (MFI, PPV, and HI) in heterogeneous ICU patients at the early phase of admission.Trial registration: The study was retrospectively registered on November 7, 2021, ChiCTR2100052999.

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Lactate Clearance as a Surrogate for Mortality in Cardiogenic Shock: Insights From the DOREMI Trial

Cited by 30 publications

References 30 publications

Outcomes in cardiogenic shock: the role of surrogate endpoints

Outcomes in cardiogenic shock: the role of surrogate endpoints

Laboratory Predictors of Prognosis in Cardiogenic Shock Complicating Acute Myocardial Infarction

Association of sublingual microcirculation parameters and capillary refill time in the early phase of ICU admission

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