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Evaluation of the factors affecting mortality after cardiac arrest - do lactate and procalcitonin concentrations have
M Kandilcik1, M Arslan, H Öksüz
1Department of Anesthesiology and Reanimation, Pazarcık State Hospital, Kahramanmaraş, Türkiye. dr.mehmetkandilcik@gmail.com.
Insights
High lactate levels and changes in lactate levels are key predictors of mortality in Intensive Care Unit (ICU) patients after cardiac arrest. Monitoring these factors aids in determining patient prognosis.
Area of Science:
- Critical Care Medicine
- Cardiology
- Biochemistry
Background:
- Patients admitted to the Intensive Care Unit (ICU) following cardiac arrest face high mortality and morbidity.
- Accurate prognostication is crucial for effective patient management and resource allocation.
Purpose of the Study:
- To determine mortality rates in post-cardiac arrest ICU patients.
- To identify risk factors and predictive factors for mortality in this patient population.
Main Methods:
- Retrospective review of 151 adult patient files admitted to ICU post-cardiac arrest (January 2017 - June 2020).
- Data collected included demographics, comorbidities, arrest details, APACHE 2 scores, blood gases (pH, HCO3), lactate levels (hourly), procalcitonin (PRC), and blood glucose.
- Patients were analyzed in survivor and non-survivor groups.
Main Results:
- Non-survivors exhibited lower pH and HCO3 levels compared to survivors.
- While initial procalcitonin (PRC) levels were similar, 24-hour PRC levels and changes were higher in non-survivors.
- Elevated 24-hour lactate levels and greater changes in lactate over 24 hours were significant predictors of mortality, identified via ROC curve and logistic regression.
Conclusions:
- Lactate levels and their changes are independent risk factors for mortality in post-cardiac arrest ICU patients.
- Integrating lactate dynamics with procalcitonin (PRC) and clinical findings can enhance prognostic accuracy.
- Early identification of high-risk patients through these markers can guide treatment strategies.
Objective:
Mortality and morbidity rates are very high in patients admitted to the Intensive Care Unit (ICU) after cardiac arrest. In this study, we aimed to determine the mortality rates, risk factors, and predictive factors for mortality in post-cardiac arrest patients admitted to the ICU.
Patients And Methods:
Following approval from the Ethics Committee, we conducted a retrospective review of patient files for individuals over the age of 18 who received treatment for cardiac arrest in the ICU from January 2017 to June 2020. Demographic data of the patients, comorbidities, arrest location, etiology of arrest, duration of hospitalization, CPR duration, APACHE 2 scores, pH and HCO3 measurements in initial blood gases, lactate levels (1st, 6th, 12th, 24th hour), change in lactate levels (24-1), rate of lactate change, procalcitonin (PRC) levels (1st and 24th hour), change in PRC levels (24-1), rate of PRC change, and blood glucose levels were recorded. The patients were divided into two groups (survivors and non-survivors groups).
Results:
151 patients were included in the study. pH and HCO3 levels were lower in the non-survivors group than in the survivors group. Initial PRC levels were similar in both groups, but the 24th-hour PRC levels were higher, and the changes in PRC levels in the first 24 hours were greater in the non-survivors group. The lactate changes in the first 24 hours were higher in the non-survivors group. The receiver operating characteristic (ROC) curve showed that the HCO3 levels, 1st-, 6th-, 12th-, and 24th-hour lactate levels, and changes in lactate levels had predictability for mortality. In logistic regression analysis, we found that high 24th-hour lactate levels and changes in lactate levels were independent risk factors for mortality.
Conclusions:
Considering PRC and lactate levels, along with clinical examination and laboratory findings, may improve the accuracy of determining the prognosis of patients experiencing cardiac arrest.
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