Published in:
Open Access
01-12-2020 | Cardiogenic Shock | Research article
Association between serum lactate levels and mortality in patients with cardiogenic shock receiving mechanical circulatory support: a multicenter retrospective cohort study
Authors:
Fernando Luís Scolari, Daniel Schneider, Débora Vacaro Fogazzi, Miguel Gus, Marciane Maria Rover, Marcely Gimenes Bonatto, Gustavo Neves de Araújo, André Zimerman, Daniel Sganzerla, Lívia Adams Goldraich, Cassiano Teixeira, Gilberto Friedman, Carisi Anne Polanczyk, Luis Eduardo Rohde, Regis Goulart Rosa, Rodrigo Vugman Wainstein
Published in:
BMC Cardiovascular Disorders
|
Issue 1/2020
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Abstract
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 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.
Results
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.
Conclusions
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.