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Published on: May 28, 2019
The 6-hour lactate clearance rate in predicting 30-day mortality in cardiogenic shock
1Department of Intensive Care Unit, Yiwu Central Hospital, Yiwu, Zhejiang, China.
Insights
The 6-hour lactate clearance rate (Δ6Lac) is a superior predictor of 30-day mortality in cardiogenic shock (CS) compared to initial lactate levels. This finding aids in early prognosis assessment for CS patients.
Area of Science:
- Cardiology
- Intensive Care Medicine
- Biomarker Research
Background:
- Early prognosis evaluation is critical for tailoring treatment in cardiogenic shock (CS).
- Lactate levels and clearance are established prognostic biomarkers in CS.
- No prior studies have directly compared 6-hour lactate clearance (Δ6Lac) with admission (L1) and 6-hour (L2) lactate levels for predicting 30-day mortality in CS.
Purpose of the Study:
- To compare the predictive accuracy of Δ6Lac, L1, and L2 for 30-day mortality in CS patients.
- To determine the optimal cut-off values for these biomarkers in predicting outcomes.
- To evaluate the independent prognostic value of Δ6Lac in CS.
Main Methods:
- Observational cohort study of 88 CS patients.
- Lactate levels measured at admission (L1) and 6 hours post-admission (L2).
- Calculated 6-hour lactate clearance (Δ6Lac).
- Used ROC curve analysis, univariate and multivariate Cox regression, and Kaplan-Meier survival analysis.
Main Results:
- Δ6Lac demonstrated the highest area under the curve (0.839), outperforming L2 (0.805) and L1 (0.668).
- Δ6Lac cut-off of 18.2% showed 84.2% sensitivity and 75.4% specificity.
- Multivariate analysis confirmed Δ6Lac (HR=5.14) and L2 (HR=8.42) as significant independent predictors of 30-day mortality.
- Higher risks of mortality were associated with L1 >6.7 mmol/L, L2 >6.1 mmol/L, and Δ6Lac ≤18.2%.
Conclusions:
- Δ6Lac is a more effective predictor of 30-day mortality in CS than admission lactate levels.
- Δ6Lac offers predictive value comparable to 6-hour lactate levels, serving as a key surrogate for early prognosis in CS.
- A Δ6Lac cut-off of 18.2% provides the most accurate early prognostic assessment in CS.
Background:
Early evaluation of prognosis in cardiogenic shock (CS) is crucial for tailored treatment selection. Both lactate clearance and lactate levels are considered useful prognostic biomarkers in patients with CS. However, there is yet no literature comparing the 6-hour lactate clearance rate (Δ6Lac) with lactate levels measured at admission (L1) and after 6 h (L2) to predict 30-day mortality in CS.
Methods:
In this observational cohort study, 95 patients with CS were treated at Department of Intensive Care Unit, Yiwu Central Hospital between January 2020 and December 2022. Of these, 88 patients met the eligibility criteria. The lactate levels were measured after admission (L1) as the baseline lactate value, and were measured after 6 h (L2) following admission. The primary endpoint of the study was survival rate at 30 days. A receiver operating characteristic curve was used for data analysis. Univariate and multivariate Cox regression analyses were performed based on Δ6Lac. Kaplan-Meier (KM) survival curves were generated to compare the 30-day survival rates among L1, L2, and Δ6Lac.
Results:
The Δ6Lac model showed the highest area under the curve value (0.839), followed by the L2 (0.805) and L1 (0.668) models. The Δ6Lac model showed a sensitivity of 84.2% and specificity of 75.4%. The L1 and L2 models had sensitivities of 57.9% each and specificities of 89.9% and 98.6%, respectively. The cut-off values for Δ6Lac, L1, and L2 were 18.2%, 6.7 mmol/L, and 6.1 mmol/L, respectively. Univariate Cox regression analysis revealed a significant association between Δ6Lac and 30-day mortality. After adjusting for five models in multivariate Cox regression, Δ6Lac remained a significant risk factor for 30-day mortality in patients with CS. In our fifth multivariate Cox regression model, Δ6Lac remained a risk factor associated with 30-day mortality (hazard ratio [HR]=5.14, 95% confidence interval [CI]: 1.48 to 17.89, P=0.010) as well as L2 (HR=8.42, 95% CI: 1.26 to 56.22, P=0.028). The KM survival curve analysis revealed that L1 >6.7 mmol/L (HR=8.08, 95% CI: 3.23 to 20.20, P <0.001), L2 >6.1 mmol/L (HR=25.97, 95% CI: 9.76 to 69.15, P <0.001), and Δ6Lac ≤18.2% (HR=8.92, 95% CI: 2.95 to 26.95, P <0.001) were associated with a higher risk of 30-day mortality.
Conclusions:
Δ6Lac is a better predictor for 30-day mortality in CS than lactate levels at admission. It has a predictive value equivalent to that of lactate level at 6 h after admission, making it an important surrogate indicator for evaluating the suitability as well as poor prognosis after CS treatment. We found that a cut-off value of 18.2% for Δ6Lac provided the most accurate assessment of early prognosis in CS.
