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

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 an...

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Published inBMC Cardiovascular Disorders
Main Authors Scolari, Fernando, Schneider, Daniel, Fogazzi, Débora Vacaro, Miguel Gus, Marciane Maria Rover, Bonatto, Marcely Gimenes, Gustavo Neves de Araújo, Zimerman, André, Sganzerla, Daniel, Lívia Adams Goldraich, Teixeira, Cassiano, Friedman, Gilberto, Carisi Anne Polanczyk, Rohde, Luis Eduardo, Regis Goulart Rosa, Wainstein, Rodrigo Vugman
Format Web Resource
LanguageEnglish
Published Durham Research Square 27.10.2020
Subjects
Extracorporeal membrane oxygenation
Mortality
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Summary: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.
DOI:10.21203/rs.3.rs-60128/v2