Serum Lactate and A Relative Change in Lactate as Predictors of Mortality in Patients With Cardiogenic Shock - Results from the Cardshock Study
Por:
Lindholm, MG, Hongisto, M, Lassus, J, Spinar, J, Parissis, J, Banaszewski, M, Silva-Cardoso, J, Carubelli, V, Salvatore, D, Sionis, A, Mebazaa, A, Veli-Pekka, H, Kober, L
Publicada:
1 ene 2020
Resumen:
Introduction: Cardiogenic shock complicating acute myocardial infarction has a very high mortality. Our present study focuses on serial measurement of lactate during admission due to cardiogenic shock and the prognostic effect of lactate and a relative change in lactate in patients after admission and the institution of intensive care treatment. Methods and Results: This is a secondary analysis of the CardShock study. Data on lactate at baseline were available on 217 of 219 patients. In the study population, the median baseline lactate was 2.8 mmol/L (min-max range, 0.5-23.1 mmol/L). At admission, lactate was predictive of 30-day mortality with an adjusted Hazard ratio (HR) of 1.20 mmol/L (95% confidence interval, CI 1.14-1.27). Within the first 24 h of admission, baseline lactate remained predictive of 30-day mortality. Lactate at 6 h had a HR of 1.14 (95% CI 1.06-1.24) and corresponding values at 12 and 24 h had a HR of 1.10 (1.04-1.17), and of HR 1.19 (95% CI 1.07-1.32), respectively. A 50% reduction in lactate within 6 h resulted in a HR of 0.82 (95% CI 0.72-0.94). Corresponding hazard ratios at 12 and 24 h, were 0.87 (95% CI 0.76-0.98) and 0.74 (95% CI 0.60-0.91), respectively. Conclusion: The main findings of the present study are that baseline lactate is a powerful predictor of 30-day mortality, lactate at 6, 12, and 24 h after admission are predictors of 30-day mortality, and a relative change in lactate is a significant predictor of survival within the first 24 h after instituting intensive care treatment adding information beyond the information from baseline values.
Filiaciones:
Lindholm, MG:
Univ Hosp Copenhagen, Rigshosp, Dept Cardiol, Copenhagen, Denmark
Hongisto, M:
Helsinki Univ Hosp, Dept Emergency Med & Serv, Helsinki, Finland
Lassus, J:
Helsinki Univ Hosp, Heart & Lung Ctr, Dept Cardiol, Helsinki, Finland
Spinar, J:
Univ Hosp Brno, Dept Internal Med & Cardiol, Brno, Czech Republic
Parissis, J:
Univ Hosp Athens, ER & Heart Failure Unit, Attikon, Greece
Banaszewski, M:
Univ Hosp Warsaw, Inst Cardiol, Intens Cardiac Therapy Clin, Warsaw, Poland
Silva-Cardoso, J:
Univ Porto, Sao Joao Hosp Ctr, Porto Med Sch, Dept Cardiol,CINTESIS, Porto, Portugal
Carubelli, V:
Univ & Civil Hosp Brescia, Dept Med & Surg Specialties Radiol Sci & Publ Hlt, Div Cardiol, Brescia, Italy
Salvatore, D:
St Andrea Hosp, Dept Emergency Med, Rome, Italy
Sionis, A:
Univ Autonoma Barcelona, Biomed Res Inst IIB SantPau, Cardiol Dept, Intens Cardiac Care Unit,Hosp Santa Creu & St Pau, Barcelona, Spain
Mebazaa, A:
Univ Paris Diderot, Dept Anesthesiol, Crit Care & Burn Unit, Sorbonne Paris Cite, Paris, France
Veli-Pekka, H:
Univ Helsinki, Helsinki Univ Hosp, Dept Emergency Care, Helsinki, Finland
Kober, L:
Univ Hosp Copenhagen, Rigshosp, Dept Cardiol, Copenhagen, Denmark
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