Serial Lactate Determinations for Prediction of Outcome After Cardiac Arrest

Abstract

We investigated the relationship between lactate clearance and outcome in patients surviving the first 48 hours after cardiac arrest. We conducted the study in the emergency department of an urban tertiary care hospital. We analyzed the data for all 48-hour survivors after successful resuscitation from cardiac arrest during a 10-year period. Serial lactate measurements, demographic data, and key cardiac arrest data were correlated to survival and best neurologic outcome within 6 months after cardiac arrest. Parameters showing significant results in univariate analysis were tested for significance in a logistic regression model. Of 1502 screened patients, 394 were analyzed. Survivors (n = 194, 49%) had lower lactate levels on admission (median, 7.8 [interquartile range, 5.4-10.8] vs 9 [6.6-11.9] mmol/L), after 24 hours (1.4 [1-2.5] vs 1.7 [1.1-3] mmol/L), and after 48 hours (1.2 [0.9-1.6] vs 1.5 [1.1-2.3] mmol/L). Patients with favorable neurologic outcome (n = 186, 47%) showed lower levels on admission (7.6 [5.4-10.3] vs 9.2 [6.7-12.1] mmol/L) and after 48 hours (1.2 [0.9-1.6] vs 1.5 [1-2.2] mmol/L). In multivariate analysis, lactate levels at 48 hours were an independent predictor for mortality (odds ratio [OR]: 1.49 increase per mmol/L, 95% confidence interval [CI]: 1.17-1.89) and unfavorable neurologic outcome (OR: 1.28 increase per mmol/L, 95% CI: 1.08-1.51). Lactate levels higher than 2 mmol/L after 48 hours predicted mortality with a specificity of 86% and poor neurologic outcome with a specificity of 87%. Sensitivity for both end points was 31%. Lactate at 48 hours after cardiac arrest is an independent predictor of mortality and unfavorable neurologic outcome. Persisting hyperlactatemia over 48 hours predicts a poor prognosis.

Blood lactate concentration as prognostic marker in critically ill children

“…Na sepse, além da inibição de vias metabólicas que transportam H + do citoplasma para a mitocôndria, ocorre o aumento da oxidação de aminoácidos de cadeia ramificada e aumento do fluxo glicolítico em função do aumento da atividade da fosfofrutoquinase 14 . Tais alterações ocorrem, na maior parte dos órgãos, aparentemente em condições adequadas de transporte e oferta de oxigênio aos tecidos 4 .…”

Blood lactate concentration as prognostic marker in critically ill children

“…Os níveis de lactato do sangue têm sido utilizados em várias situações, entre elas como marcador de hipoperfusão tecidual em pacientes com choque, indicador de ressuscitação adequada após o choque, índice prognóstico pós-ressuscitação, fator prognóstico em situações de doenças graves 2 e como diagnóstico etiológico 3,4 .…”

Prognostic Value of Red Cell Distribution Width in Critically Ill Patients and Comparison with Intensive Care Unit Scoring Systems

“…Blood lactate level is one of the most frequently used parameters (2). Tissue hypoxia during shock and the condition after shock resuscitation are the indicators of prognosis for critical cases in terms of identification of severity and mortality risk of diseases and must be considered a useful indicator for conditions such as etiologic diagnosis (3,4). Red cell distribution width (RDW) is one such indicator.…”