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- Title
Association between serum lactate levels and mortality in patients with cardiogenic shock receiving mechanical circulatory support: a multicenter retrospective cohort study.
- Authors
Scolari, Fernando Luís; Schneider, Daniel; Fogazzi, Débora Vacaro; Gus, Miguel; Rover, Marciane Maria; Bonatto, Marcely Gimenes; de Araújo, Gustavo Neves; Zimerman, André; Sganzerla, Daniel; Goldraich, Lívia Adams; Teixeira, Cassiano; Friedman, Gilberto; Polanczyk, Carisi Anne; Rohde, Luis Eduardo; Rosa, Regis Goulart; Wainstein, Rodrigo Vugman
- Abstract
<bold>Background: </bold>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®.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.
- Subjects
BRAZIL; CARDIOGENIC shock; MECHANICAL shock; EXTRACORPOREAL membrane oxygenation; RECEIVER operating characteristic curves; PROGNOSIS
- Publication
BMC Cardiovascular Disorders, 2020, Vol 20, Issue 1, pN.PAG
- ISSN
1471-2261
- Publication type
journal article
- DOI
10.1186/s12872-020-01785-7