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

• Published in: BMC cardiovascular disorders Vol. 20; no. 1; p. 496
• Main Authors: Scolari, Fernando Luís, Schneider, Daniel, Fogazzi, Débora Vacaro, Gus, Miguel, Rover, Marciane Maria, Bonatto, Marcely Gimenes, de Araújo, Gustavo Neves, Zimerman, André, Sganzerla, Daniel, Goldraich, Lívia Adams, Teixeira, Cassiano, Friedman, Gilberto, Polanczyk, Carisi Anne, Rohde, Luis Eduardo, Rosa, Regis Goulart, Wainstein, Rodrigo Vugman
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 24.11.2020; BioMed Central
• Subjects: Adult; Angioplasty; Biomarkers; Biomarkers - blood; Brazil; Cardiogenic shock; Care and treatment; Cohort analysis; Drug dosages; Extracorporeal membrane oxygenation; Extracorporeal Membrane Oxygenation - adverse effects; Extracorporeal Membrane Oxygenation - instrumentation; Extracorporeal Membrane Oxygenation - mortality; Female; Health aspects; Heart attacks; Heart failure; Heart-Assist Devices; Humans; Intensive care; Lactates; Lactic acid; Lactic Acid - blood; Male; Measurement; Middle Aged; Mortality; Oxygenation; Oxygenators, Membrane; Patients; Predictive Value of Tests; Prognosis; Prosthesis Implantation - adverse effects; Prosthesis Implantation - instrumentation; Prosthesis Implantation - mortality; Retrospective Studies; Risk Factors; Shock, Cardiogenic - blood; Shock, Cardiogenic - diagnosis; Shock, Cardiogenic - mortality; Shock, Cardiogenic - therapy; Time Factors; Treatment Outcome; Variables; Brazil; Impella; Extracorporeal membrane oxygenation; Lactic acid; Cardiogenic shock; Mechanical circulatory support
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-020-01785-7

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 . Serum lactate and clearance were measured before MCS and at 1 h, 6 h, 12 h, and 24 h 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. VA-ECMO was the most common MCS modality (58%). Serum lactate levels at all time points and lactate clearance after 6 h were associated with mortality on unadjusted and adjusted analyses. Lactate levels were higher in non-survivors at 6 h, 12 h, and 24 h after MCS. Serum lactate > 1.55 mmol/L at 24 h 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 24 h was associated with 100% mortality. Serum lactate was an important prognostic biomarker in cardiogenic shock treated with temporary MCS. Serum lactate and lactate clearance at 24 h were the strongest independent predictors of short-term survival.