Association between serum lactate levels and mortality in patients with cardiogenic shock receiving mechanical circulato
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RESEARCH ARTICLE
Open Access
Association between serum lactate levels and mortality in patients with cardiogenic shock receiving mechanical circulatory support: a multicenter retrospective cohort study Fernando Luís Scolari1,2* , Daniel Schneider1, Débora Vacaro Fogazzi1, Miguel Gus3, Marciane Maria Rover3,4, Marcely Gimenes Bonatto5, Gustavo Neves de Araújo2,6, André Zimerman6, Daniel Sganzerla1, Lívia Adams Goldraich7,8, Cassiano Teixeira9, Gilberto Friedman10,11, Carisi Anne Polanczyk2,3,11, Luis Eduardo Rohde2,3,11, Regis Goulart Rosa1 and Rodrigo Vugman Wainstein1,2
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. Keywords: Cardiogenic shock, Extracorporeal membrane oxygenation, Impella, Mechanical circulatory support, Lactic acid Background Cardiogenic shock is a high-mortality condition with increasing incidence [1]. The hemodynamic impairment caused by cardiogenic shock triggers an inflammatory
*Correspondence: [email protected] 1 Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos 630, 10º andar, Porto Alegre, RS 90035‑001, Brazil Full list of author information is available at the end of the article
cascade, which leads to circulatory collapse and tissue perfusion impairment [2]. Lactate is a metabolic byproduct of anaerobic glycolysis and a reliable marker of tissue hypoperfusion [3]. It has been used both as prognostic variable and as therapeutic target in different clinical scenarios of shock [4, 5]. Treating cardiogenic shock with MCS may enhance macro- and microcirculation, improving tissue perfusion [6].The increase in tissue oxygenation
© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use
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