Blood Lactate as a Reliable Marker for Mortality of Pediatric Refractory Cardiogenic Shock Requiring Extracorporeal Membrane Oxygenation

Yang, Liying; Fan, Yuqi; Lin, Ru; He, Wenjuan

doi:10.1007/s00246-018-2033-2

“…This value is supported by the literature as a threshold to trigger MCS, however, this cutoff is supported only by expert opinion. Previous cohorts of MCS patients have shown higher initial lactate levels, ranging from 7 to 14 mmol/L in the survival group than the one found in our study (4.0; 2.62 to 6.3), which may reflect a distinct population [5,8,14,24]. Differences found in baseline lactate between survivors and non-survivors (4.0 vs. 7.5 mmol/L) in our study may be related to distinct cardiogenic shock etiologies and a higher burden of comorbidities such as hypertension and diabetes.…”

Section: Discussioncontrasting

confidence: 68%

Association between serum lactate levels and mortality in patients with cardiogenic shock receiving mechanical circulatory support: a multicenter retrospective cohort study

Scolari

¹

,

Schneider

²

,

Fogazzi

³

et al. 2020

BMC Cardiovasc Disord

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Background 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®. Methods 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. Results 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. Conclusions 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.

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“…This value is supported by the literature as a threshold to trigger MCS, however, this cutoff is supported only by expert opinion. Previous cohorts of MCS patients have shown higher initial lactate levels, ranging from 7 to 14 mmol/L in the survival group than the one found in our study (4.0; 2.62 to 6.3), which may re ect a distinct population [11,14,17,26]. Differences found in baseline lactate between survivors and non-survivors (4.0 vs. 7.5 mmol/L) in our study may be related to distinct cardiogenic shock etiologies and a higher burden of comorbidities such as hypertension and diabetes.…”

Section: Discussioncontrasting

confidence: 62%

Association between serum lactate levels and mortality in patients with cardiogenic shock receiving mechanical circulatory support: a multicenter retrospective cohort study

Scolari

¹

,

Schneider

²

,

Fogazzi

³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: 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®.Methods: Serum lactate and clearance were measured before MCS and at 1h, 6h, 12h, and 24h 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.Results: VA-ECMO was the most common MCS modality (58%). Serum lactate levels at all time points and lactate clearance after 6h were associated with mortality on unadjusted and adjusted analyses. Lactate levels were higher in non-survivors at 6h, 12h, and 24h after MCS. Serum lactate > 1.55 mmol/L at 24h 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 24h was associated with 100% mortality.Conclusions: Serum lactate was an important prognostic biomarker in cardiogenic shock treated with temporary MCS. Serum lactate and lactate clearance at 24h were the strongest independent predictors of short-term survival.

show abstract

“…Although the literature supports a baseline lactate of 4 mmol/L to trigger MCS, this cutoff is supported only by expert opinion. Several cohorts of MCS patients have shown higher initial lactate levels, ranging from 7 to 14 mmol/L in the survival group [9,11,14,23] [9,11,14,23] than the one found in our study (4.0; 2.62 to 6.3) [9,11,14,23]. These data highlights that, although non-survivors usually have higher initial lactate levels, there is a wide range of initial lactates in the survival group.…”

Section: Discussionsupporting

confidence: 46%

Association between serum lactate levels and mortality in patients with cardiogenic shock receiving mechanical circulatory support: a multicenter retrospective cohort study

Scolari

¹

,

Schneider

²

,

Fogazzi

³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: 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®.Methods: Serum lactate and clearance were measured before MCS and at 1h, 6h, 12h, and 24h 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.Results: VA-ECMO was the most common MCS modality (58%). Serum lactate levels at all time points and lactate clearance after 6h were associated with mortality on unadjusted and adjusted analyses. Lactate levels were higher in non-survivors at 6h, 12h, and 24h after MCS. Serum lactate > 1.55 mmol/L at 24h 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 24h was associated with 100% mortality.Conclusions: Serum lactate was an important prognostic biomarker in cardiogenic shock treated with temporary MCS. Serum lactate and lactate clearance at 24h were the strongest independent predictors of short-term survival.

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Blood Lactate as a Reliable Marker for Mortality of Pediatric Refractory Cardiogenic Shock Requiring Extracorporeal Membrane Oxygenation

Cited by 25 publications

References 21 publications

Association between serum lactate levels and mortality in patients with cardiogenic shock receiving mechanical circulatory support: a multicenter retrospective cohort study

Association between serum lactate levels and mortality in patients with cardiogenic shock receiving mechanical circulatory support: a multicenter retrospective cohort study

Association between serum lactate levels and mortality in patients with cardiogenic shock receiving mechanical circulatory support: a multicenter retrospective cohort study

Association between serum lactate levels and mortality in patients with cardiogenic shock receiving mechanical circulatory support: a multicenter retrospective cohort study

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