Lactate clearance in cardiogenic shock following ST elevation myocardial infarction: A pilot study

Attanà, Paola; Lazzeri, Chiara; Chiostri, Marco; Picariello, Claudio; Gensini, Gian Franco; Valente, Serafina

doi:10.3109/17482941.2011.655293

Cited by 61 publications

(34 citation statements)

References 29 publications

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“…It is a marker of poor outcome if measured during the initial 24 h of intensive care unit admission in CS [5] or in overall critically ill patient population [6]. Our study confirmed the prognostic value of lactate during the first 24 h in CS.…”

Section: Discussionsupporting

confidence: 80%

Adrenomedullin: a marker of impaired hemodynamics, organ dysfunction, and poor prognosis in cardiogenic shock

Tolppanen

Rivas‐Lasarte

Lassus

et al. 2017

Ann. Intensive Care

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BackgroundThe clinical CardShock risk score, including baseline lactate levels, was recently shown to facilitate risk stratification in patients with cardiogenic shock (CS). As based on baseline parameters, however, it may not reflect the change in mortality risk in response to initial therapies. Adrenomedullin is a prognostic biomarker in several cardiovascular diseases and was recently shown to associate with hemodynamic instability in patients with septic shock. The aim of our study was to evaluate the prognostic value and association with hemodynamic parameters of bioactive adrenomedullin (bio-ADM) in patients with CS.MethodsCardShock was a prospective, observational, European multinational cohort study of CS. In this sub-analysis, serial plasma bio-ADM and arterial blood lactate measurements were collected from 178 patients during the first 10 days after detection of CS.ResultsBoth bio-ADM and lactate were higher in 90-day non-survivors compared to survivors at all time points (P < 0.05 for all). Lactate showed good prognostic value during the initial 24 h (AUC 0.78 at admission and 0.76 at 24 h). Subsequently, lactate returned normal (≤2 mmol/L) in most patients regardless of later outcome with lower prognostic value. By contrast, bio-ADM showed increasing prognostic value from 48 h and beyond (AUC 0.71 at 48 h and 0.80 at 5–10 days). Serial measurements of either bio-ADM or lactate were independent of and provided added value to CardShock risk score (P < 0.001 for both). Ninety-day mortality was more than double higher in patients with high levels of bio-ADM (>55.7 pg/mL) at 48 h compared to those with low bio-ADM levels (49.1 vs. 22.6%, P = 0.001). High levels of bio-ADM were associated with impaired cardiac index, mean arterial pressure, central venous pressure, and systolic pulmonary artery pressure during the study period. Furthermore, high levels of bio-ADM at 48 to 96 h were related to persistently impaired cardiac and end-organ function.ConclusionsBio-ADM is a valuable prognosticator and marker of impaired hemodynamics in CS patients. High levels of bio-ADM may show shock refractoriness and developing end-organ dysfunction and thus help to guide therapeutic approach in patients with CS. Study identifier of CardShock study NCT01374867 at clinicaltrials.govElectronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0229-2) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 80%

Adrenomedullin: a marker of impaired hemodynamics, organ dysfunction, and poor prognosis in cardiogenic shock

Tolppanen

Rivas‐Lasarte

Lassus

et al. 2017

Ann. Intensive Care

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“…One pilot study advocated that 12-h lactate clearance <10% identifies a subset of patients at higher risk for death over the short- and long-term among patients with cardiogenic shock following AMI 21. In our study, lower lactate clearance for 48 hours (<70%) remained a significant predictor of in-hospital mortality after adjusting for covariates.…”

Section: Discussionsupporting

confidence: 46%

Clinical Outcomes of Patients with Acute Myocardial Infarction Complicated by Severe Refractory Cardiogenic Shock Assisted with Percutaneous Cardiopulmonary Support

et al. 2014

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PurposeLimited data are available on the role of percutaneous cardiopulmonary support (PCPS) for the treatment of acute myocardial infarction (AMI) patients with cardiogenic shock. We investigated the clinical outcomes and predictors of in-hospital mortality after PCPS in patients with AMI complicated by severe refractory cardiogenic shock.Materials and MethodsFrom January 2004 to December 2011, we analyzed data from 96 consecutive AMI patients with cardiogenic shock assisted by a PCPS system. The primary outcome was in-hospital mortality. The predictors of in-hospital mortality were determined by a Cox proportional-hazards model.ResultsIn-hospital mortality occurred in 51 (53.1%) patients and 58 (60.4%) patients were able to be weaned from PCPS. Cardiopulmonary resuscitation (CPR) was performed in 61 (63.5%) patients before PCPS initiation. On multivariate analysis, age ≥67 years [adjusted hazard ratio (HR), 4.74; 95% confidence interval (CI), 2.27-9.93; p<0.001], CPR (adjusted HR, 2.32; 95% CI, 1.11-4.85; p=0.03), lactate clearance for 48 hours <70% (adjusted HR, 2.50; 95% CI, 1.04-6.05; p=0.041), and unsuccessful revascularization (adjusted HR, 3.57; 95% CI, 1.85-6.90; p=0.002) were independent predictors of in-hospital mortality after PCPS in patients with AMI complicated by cardiogenic shock.ConclusionIn spite of PCPS management, AMI patients complicated by severe refractory cardiogenic shock demonstrated high mortality. Older age, CPR, lower lactate clearance for 48 hours, and unsuccessful revascularization were independent predictors of in-hospital mortality.

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“…Lactic acidosis typically occurs when cells are short of oxygen, forcing them to metabolize glucose anaerobically, which leads to lactate formation. Therefore, elevated lactate is indicative of tissue hypoxia as well as hypoperfusion, which occurs amongst other incidences during shock (14)(15)(16).…”

Section: Page 5 Of 18mentioning

confidence: 99%

Lactate as a diagnostic marker in transient loss of consciousness

Matz

Zdebik

Zechbauer

et al. 2016

Seizure

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Lactate clearance in cardiogenic shock following ST elevation myocardial infarction: A pilot study

Abstract: In patients with CS following STEMI, 12-h lactate clearance<10% identifies a subset of patients at higher risk for death at short and long-term.

Cited by 61 publications

References 29 publications

Adrenomedullin: a marker of impaired hemodynamics, organ dysfunction, and poor prognosis in cardiogenic shock

Adrenomedullin: a marker of impaired hemodynamics, organ dysfunction, and poor prognosis in cardiogenic shock

Clinical Outcomes of Patients with Acute Myocardial Infarction Complicated by Severe Refractory Cardiogenic Shock Assisted with Percutaneous Cardiopulmonary Support

Lactate as a diagnostic marker in transient loss of consciousness

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