The peak of blood lactate during the first 24h predicts mortality in acute coronary syndrome patients under extracorporeal membrane oxygenation

Rigamonti, Fabio; Montecucco, Fabrizio; Boroli, Filippo; Rey, Florian; Gencer, Baran; Çıkırıkçıoğlu, Mustafa; Reverdin, Stephane; Noble, Stéphane; Roffi, Marco; Banfı, Carlo; Giraud, Raphaël

doi:10.1016/j.ijcard.2016.07.065

“…Although the literature supports a baseline lactate of 4 mmol/L to trigger MCS, this cutoff is supported only by expert opinion. Several cohorts of MCS patients have shown higher initial lactate levels, ranging from 7 to 14 mmol/L in the survival group [9,11,14,23] [9,11,14,23] than the one found in our study (4.0; 2.62 to 6.3) [9,11,14,23]. These data highlights that, although non-survivors usually have higher initial lactate levels, there is a wide range of initial lactates in the survival group.…”

Section: Discussionsupporting

confidence: 47%

“…A cohort study of patients with cardiogenic shock who received percutaneous extracorporeal life support, mainly in the post-cardiopulmonary resuscitation setting, found that initial lactate level was able to discriminate survivors from non-survivors, after multivariable analysis [22]. These results, however, are in disagreement with previous studies [9,11,21]. The discrepancy in association of initial lactate levels with mortality may re ect time from insult to initiation of mechanical support, differences in shock etiology, and differences in comorbidity pro le.…”

Section: Discussionmentioning

confidence: 81%

“…However, there is no consensus regarding optimal clearance of lactate within time. In a cohort of patients with acute coronary syndrome complicated by cardiogenic shock, a lactate cutoff value of 11 mmol/L in the rst 24 hours was associated with a mortality rate of 57%, but such an elevated cutoff has little clinical utility [9]. To further assess lactate levels over time, Slottosch et al evaluated patients on VA-ECMO in multiple clinical scenarios.…”

Section: Discussionmentioning

confidence: 99%

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

Scolari

¹

,

Schneider

²

,

Fogazzi

³

et al. 2020

Preprint

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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.

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“…To speak of, the peak of blood lactate is a very powerful indicator to predicts mortality. 20 – 22 In our study, Lac 24max has been shown to be an independent predictor of both short-term and long-term mortality and superior to Lac adm according to the comparison results of ROC. A retrospective study put forward that a score consists of lactate and the qSOFA perform better than the qSOFA alone in predicting mortality.…”

Section: Discussionmentioning

confidence: 50%

<p>Association of Different Lactate Indices with 30-Day and 180-Day Mortality in Patients with ST-Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention: A Retrospective Cohort Study</p>

Hu¹,

Lin²,

Xu³

et al. 2020

TCRM

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0

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Background Admission lactate level has been reported as a useful marker of mortality. In this study, we compared the relative value of different lactate indices to predict survival in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods This was a retrospective observational study including consecutive patients with STEMI undergoing primary PCI who admitted to the Coronary Care Unit of the First Affiliated Hospital of Wenzhou Medical University between 2014 and 2017. The predictive value of lactate indices for mortality was compared using receiver operator characteristic (ROC) analysis, and DeLong’s test was used to compare the AUC. We compared the AUC between GRACE score and GRACE score + lactate index. Results A total of 1080 patients were included. Fifty-nine died in 30 days and 68 died in 180 days. Most lactate indices (Lac adm , Lac 24max , Lac 24min and Lac 24tw ) were significantly lower in survivors (all P<0.001). In Cox proportional hazards model, each lactate index showed as an independent factor of 30-day and 180-day mortality except Lac Δ . Kaplan–Meier curves demonstrated that the patients of higher lactate indices group had higher rates of mortality (all P<0.0001, except Lac Δ P=0.0485). In receiver operator characteristic analysis, Lac 24max was significantly larger than Lac adm (P<0.001) while the AUC value for Lac adm was similar to Lac 24min and Lac 24tw . Lac 24tw improved the predictive probability of 30-day mortality (P=0.0415). Lac 24max improved the predictive probability of GRACE score for both 30-day and 180-day mortality (P<0.05). Conclusion In patients with STEMI undergoing primary PCI, most lactate indices are all associated with 30-day and 180-day mortality except LacΔ. In prediction of both 30-day and 180-day mortality, Lac 24max is superior to Lac adm and significantly enhances the ability of risk stratification and prognostic evaluation when adding Lac 24max to the GRACE score.

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“…Lactate is a metabolic byproduct of anaerobic glycolysis and a reliable marker of tissue hypoperfusion [9]. It has been used both as prognostic variable and as therapeutic target in different clinical scenarios of shock [10,11]. Treating cardiogenic shock with MCS may enhance macro-and microcirculation, improving tissue perfusion [12].The increase in tissue oxygenation might reduce lactate production, which makes it a good biomarker [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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

Scolari

¹

,

Schneider

²

,

Fogazzi

³

et al. 2020

Preprint

View full text Add to dashboard Cite

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.

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The peak of blood lactate during the first 24h predicts mortality in acute coronary syndrome patients under extracorporeal membrane oxygenation

Cited by 28 publications

References 32 publications

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

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

<p>Association of Different Lactate Indices with 30-Day and 180-Day Mortality in Patients with ST-Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention: A Retrospective Cohort Study</p>

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

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