Persistent hyperlactataemia is related to high rates of in-hospital adverse events and poor outcome in acute heart failure

Abstract

Background: Although lactate is a well-established marker in intensive care, our understanding of its utility in acute heart failure (AHF) is modest and based on studies with a single measurement of this marker. Aim: We aimed to investigate whether persistent elevation of lactate during hospitalisation is related to a higher risk of adverse events. Methods: We conducted a prospective study to assess AHF patients hospitalised in one cardiac centre. The diagnosis of persistent hyperlactataemia was based on two measurements of the marker (on admission and at 24 h of hospitalisation) and it was defined as lactate elevation (≥ 2 mmol/L) at both time points. Results: The population consisted of 222 patients at a mean age of 70 ± 13 years. Mean ejection fraction and creatinine level on admission were 37% ± 16% and 1.36 ± 0.51 mg/dL, respectively. The percentage of patients with elevated lactates on admission, at 24 h of hospitalisation, and persistent hyperlactataemia were 47%, 35%, and 24%, respectively. The group with persistent hyperlactataemia did not differ in most clinical and laboratory variables from the rest of the population. Patients with persistent hyperlactataemia had higher rate of adverse events during hospitalisation: worsening of heart failure (22.6% vs. 6.5%, p < 0.05), inotrope use (22.6% vs. 5.3%, p < 0.05), and increase of N-terminal pro-B-type natriuretic peptide at 48 h of hospitalisation (30% vs. 18%, p < 0.05). Persistent hyperlactataemia was an independent predictor of one-year mortality (hazard ratio 2.5, 95% confidence interval 1.5-4.3, p < 0.001). Conclusions: Persistent hyperlactataemia within the first 24 h of hospitalisation is a predictor of a worse outcome in AHF and is related to higher rates of in-hospital adverse events and one-year mortality.

Elevated plasma endothelin‐1 is related to low natriuresis, clinical signs of congestion, and poor outcome in acute heart failure

“…However, those patients with elevated ET‐1 had significantly lower urine sodium excretion, which only confirms the postulate for bi‐dimensional assessment of the kidney function in AHF, through the prism of natriuresis and eGFR, as two separate processes 16 . Moreover, our data suggest an interesting signal of interaction between congestion, liver dysfunction, elevation of serum lactates, and high ET‐1, all of which are signs of poor outcome in AHF 18–22 . The data from clinical trials that tested the endothelin receptor antagonists in heart failure also revealed an indirect connection between endothelin and water/sodium handling, as patients in active treatment arms of the studies tended to accumulate fluid 23 .…”

Novel biomarkers in heart failure and cardio-oncology

“…In general, a good biomarker should add clinical information that could affect the treatment of the patient and be universally available. One such new biomarker was found in the current study by Biegus et al [12]. The authors showed that persistent hyperlactataemia in 222 acute HF (AHF) patients, defined as lactate level ≥ 2 mmol/L on admission and after 24 h, was associated with more intensive HF treatment, worsening of HF and higher one-year all-cause mortality.…”

Elevated Lactate Levels in Acute Pulmonary Embolism Are Associated with Prothrombotic Fibrin Clot Properties: Contribution of NETs Formation

“…Cancer and pregnancy are known prothrombotic factors, which negatively alter fibrin clot phenotype [38,39] and modulate NET formation [39,40]. Third, all laboratory parameters were assessed on admission, while hyperlactatemia may be persistent [41] and might modulate inflammatory response and coagulation activation.…”