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Prognostic value of lactate in patients with cardiogenic shock with and without cardiac arrest
Uwe Zeymer1,2,3, Anne Freund4, Taoufik Ouarrak5
1Institut Für Herzinfarktforschung, Bremserstr. 79, 67063, Ludwigshafen, Germany. uwe.zeymer@t-online.de.
Insights
Admission arterial lactate is a key predictor of 1-year mortality in cardiogenic shock (CS), regardless of whether patients experienced cardiac arrest (CA). Higher lactate levels consistently indicate a worse prognosis in CS patients with or without CA.
Area of Science:
- Cardiology
- Critical Care Medicine
- Biomarkers
Background:
- Arterial lactate is a known prognostic marker for infarct-related cardiogenic shock (CS).
- The prognostic significance of lactate in CS patients with versus without pre-hospital cardiac arrest (CA) is not well-defined.
Purpose of the Study:
- To investigate the prognostic value of admission arterial lactate levels in patients with infarct-related CS.
- To determine if the prognostic value of lactate differs between CS patients with and without pre-hospital CA.
Main Methods:
- Pooled analysis of three randomized clinical trials (IABP-SHOCK II, CULPRIT-SHOCK, ECLS-SHOCK) involving 1401 CS patients.
- Patients were stratified by the presence or absence of pre-hospital CA.
- Admission lactate levels were categorized into tertiles (<3.6, 3.6-7.1, >7.1 mmol/L); primary endpoint was 1-year all-cause mortality.
Main Results:
- Higher admission lactate levels were linearly associated with increased 1-year mortality (AUC 0.65).
- Patients with CA had higher lactate levels (31.6% in highest tertile vs. 8.8% without CA).
- Lactate levels significantly predicted 1-year mortality across all tertiles, irrespective of CA status (highest tertile: 66.7% mortality with CA, 81.8% without CA).
Conclusions:
- Admission arterial lactate is a significant predictor of 1-year mortality in infarct-related CS.
- The prognostic value of arterial lactate in CS is consistent, regardless of pre-hospital CA status.
- Elevated lactate levels, particularly in the highest tertile, are associated with the greatest mortality risk in CS patients, even those without prior CA.
Background:
Arterial lactate on admission is a well-established marker of shock severity and prognosis in infarct-related cardiogenic shock (CS). However, it remains unclear whether its prognostic value differs between patients with and without pre-hospital cardiac arrest (CA).
Methods:
We performed a pooled analysis of three randomized clinical trials on CS (IABP-SHOCK II, CULPRIT-SHOCK, and ECLS-SHOCK). Patients were stratified based on the presence or absence of pre-hospital CA. Admission arterial lactate levels were categorized into tertiles: < 3.6, 3.6-7.1, and > 7.1 mmol/L. The primary endpoint was 1-year all-cause mortality.
Results:
A total of 1401 patients (804 with CA and 597 without CA) were included. Higher admission lactate levels were associated with a linear increase in 1-year mortality. The prognostic performance of arterial lactate, assessed by the area under the curve (AUC), was 0.65 (95% CI 0.63-0.67). Patients with CA were more frequently represented in the highest lactate tertile compared to those without CA (31.6% vs. 8.8%). Across all tertiles, lactate levels were significantly associated with 1-year mortality, irrespective of CA status: 39.8% vs. 41.4% in the lowest tertile (p = 0.73), 48.6% vs. 50.8% in the intermediate tertile (p = 0.61), and 66.7% vs. 81.8% in the highest tertile (p = 0.0023), for CA and no-CA patients, respectively.
Conclusions:
Admission arterial lactate is associated with 1-year mortality in infarct-related CS, regardless of pre-hospital CA. Although patients without CA generally had lower lactate levels, those in the highest lactate tertile experienced the highest mortality risk.
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