Association between serum lactate levels, lactate clearance, and survival to discharge in post-cardiac arrest patientsCategory: Post Resuscitation Care

Objectives: Early recognition and prevention of in-hospital cardiac arrest (IHCA) play an increasingly important role in the Chain of Survival. However, clinical tools for predicting IHCA in the emergency department (ED) are scanty. We sought to evaluate the role of serum lactate in predicting ED-based IHCA. Methods: Data were retrieved from 733,398 ED visits over a 7-year period in a tertiary medical centre. We selected one ED visit per person and excluded out-of-hospital cardiac arrest, children, or those without lactate measurements. Patient demographics, computerised triage information, and serum lactate levels were extracted. The initial serum lactate levels were grouped into normal (≤2 mmol/L), moderately elevated (2 < lactate ≤ 4), and highly elevated (>4 mmol/L) categories. The primary outcome was ED-based IHCA. Results: A total of 17,392 adult patients were included. Of them, 342 (2%) developed IHCA. About 50% of the lactate levels were normal, 30% were moderately elevated, and 20% were highly elevated. In multivariable analysis, the group with highly elevated lactate had an 18-fold increased risk of IHCA (adjusted odds ratio [OR], 18.0; 95% confidence interval [CI], 11.5–28.2), compared with the normal lactate group. In subgroup analysis, the poor lactate-clearance group (<2.5%/h) was associated with a 7.5-fold higher risk of IHCA (adjusted OR, 7.5; 95%CI, 3.7–15.1) compared with the normal clearance group. Conclusions: Elevated lactate levels and poor lactate clearance were strongly associated with a higher risk of ED-based IHCA. Clinicians may consider a more liberal sampling of lactate in patients at higher risk of IHCA with follow-up of abnormal levels.

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Lactate Clearance Predicts Good Neurological Outcomes in Cardiac Arrest Patients Treated with Extracorporeal Cardiopulmonary Resuscitation

Journal of Clinical Medicine ◽

10.3390/jcm8030374 ◽

2019 ◽

Vol 8 (3) ◽

pp. 374 ◽

Cited By ~ 10

Author(s):

Christian Jung ◽

Sandra Bueter ◽

Bernhard Wernly ◽

Maryna Masyuk ◽

Diyar Saeed ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Cox Regression ◽

Lactate Concentration ◽

Lactate Clearance ◽

Serum Lactate ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Neurological Outcomes ◽

Baseline Characteristics ◽

The Impact

Background: We evaluated critically ill patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) due to cardiac arrest (CA) with respect to baseline characteristics and laboratory assessments, including lactate and lactate clearance for prognostic relevance. Methods: The primary endpoint was 30-day mortality. The impact on 30-day mortality was assessed by uni- and multivariable Cox regression analyses. Neurological outcome assessed by Glasgow Outcome Scale (GOS) was pooled into two groups: scores of 1–3 (bad GOS score) and scores of 4–5 (good GOS score). Results: A total of 93 patients were included in the study. Serum lactate concentration (hazard ratio (HR) 1.09; 95% confidence interval (CI) 1.04–1.13; p < 0.001), hemoglobin, (Hb; HR 0.87; 95% CI 0.79–0.96; p = 0.004), and catecholamine use were associated with 30-day-mortality. In a multivariable model, only lactate clearance (after 6 h; OR 0.97; 95% CI 0.94–0.997; p = 0.03) was associated with a good GOS score. The optimal cut-off of lactate clearance at 6 h for the prediction of a bad GOS score was at ≤13%. Patients with a lactate clearance at 6 h ≤13% evidenced higher rates of bad GOS scores (97% vs. 73%; p = 0.01). Conclusions: Whereas lactate clearance does not predict mortality, it was the sole predictor of good neurological outcomes and might therefore guide clinicians when to stop ECPR.

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206. The Utility of Lactate as a Biomarker for Sepsis in Cancer Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.250 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S106-S107

Author(s):

Suji Mathew ◽

Leah Whitman

Keyword(s):

Liver Metastasis ◽

Lactic Acidosis ◽

Cancer Patients ◽

Antimicrobial Stewardship ◽

Antibiotic Use ◽

Lactate Clearance ◽

Serum Lactate ◽

Liver Involvement ◽

Significant Difference ◽

Lactate Levels

Abstract Background Serum lactate is included in the initial assessment of patients with sepsis. However, cancer patients develop lactic acidosis for a variety of reasons and are underrepresented in most studies. Therefore, elevated lactate levels may lead to overdiagnosis of sepsis and excessive antibiotic use. The purpose of this study is to evaluate the utility of lactate as a biomarker for sepsis in cancer patients. The primary endpoint is the rate of 24-hour lactate clearance between infectious and non-infectious causes of lactic acidosis in cancer patients. Secondary objectives explore the duration of antibiotic therapy (DOT), the impact of liver metastasis on serum lactate levels, and the role of procalcitonin in distinguishing between infectious and non-infectious causes of lactic acidosis. Methods Retrospective chart review by Antimicrobial Stewardship team Figure 1: Study design Results Preliminary data from a random subset of our sample (45/150) suggests there is no difference in mean serum lactate levels between infectious and non-infectious groups (4.6 vs 6.4). However, a substantial difference exists in the rate of 24h lactate clearance, although the difference was not statistically significant (58.3% vs 33%; p=0.13) (Fig2). There was a significant difference in antibiotic DOT (12.6 vs 3.3; p< 0.0001) presumably due to robust antimicrobial stewardship practices. Consistent with previous studies, there was a significant difference in procalcitonin levels between groups (27.2 vs 1.5, p=0.04). A sub-analysis of non-infectious patients with liver metastasis revealed a statistically significant difference in the rate of lactate clearance (21% vs 61.5%, p=0.03) (Fig3) suggesting that liver involvement impacts lactate clearance. Antibiotic DOT were also longer in non-infectious patients with liver metastasis (4.53 vs 1.38, p=0.02). Comparing end points between cancer patients with and witthout infection. Liver involvement affecting Lactate clearance in patients without infection. Conclusion Cancer patients often manifest SIRS criteria at baseline which may lead to the overdiagnosis of infection and excessive antibiotic usage. Our observation is that lactate clearance as opposed to degree of lactic acidosis may be a more accurate indicator of infection in cancer patients especially those with liver involvement. This information may mitigate unnecessary antibiotic use in cancer patients with persistent lactic acidosis unrelated to infection. Disclosures All Authors: No reported disclosures

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Correlation between serum lactate, lactate clearance and survival after cardiac arrest

Resuscitation ◽

10.1016/j.resuscitation.2016.07.203 ◽

2016 ◽

Vol 106 ◽

pp. e83-e84

Author(s):

Femke Vanwetswinkel ◽

Philippe Dewolf

Keyword(s):

Cardiac Arrest ◽

Lactate Clearance ◽

Serum Lactate

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

10.21203/rs.3.rs-60128/v2 ◽

2020 ◽

Author(s):

Fernando Scolari ◽

Daniel Schneider ◽

Débora Vacaro Fogazzi ◽

Miguel Gus ◽

Marciane Maria Rover ◽

...

Keyword(s):

Cardiogenic Shock ◽

Prognostic Value ◽

Mechanical Circulatory Support ◽

Lactate Clearance ◽

Serum Lactate ◽

Circulatory Support ◽

Term Survival ◽

Time Points ◽

Lactate Levels ◽

Va Ecmo

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

10.21203/rs.3.rs-60128/v1 ◽

2020 ◽

Author(s):

Fernando Scolari ◽

Daniel Schneider ◽

Débora Vacaro Fogazzi ◽

Miguel Gus ◽

Marciane Maria Rover ◽

...

Keyword(s):

Cardiogenic Shock ◽

Prognostic Value ◽

Mechanical Circulatory Support ◽

Lactate Clearance ◽

Serum Lactate ◽

Circulatory Support ◽

Term Survival ◽

Time Points ◽

Lactate Levels ◽

Va Ecmo

Abstract 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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Use of serum lactate levels to predict survival for patients with out-of-hospital cardiac arrest: A cohort study

Emergency Medicine Australasia ◽

10.1111/1742-6723.12560 ◽

2016 ◽

Vol 28 (2) ◽

pp. 171-178 ◽

Cited By ~ 16

Author(s):

Teresa A Williams ◽

Ry Martin ◽

Antonio Celenza ◽

Alexandra Bremner ◽

Daniel Fatovich ◽

...

Keyword(s):

Cardiac Arrest ◽

Cohort Study ◽

Serum Lactate ◽

Lactate Levels ◽

Hospital Cardiac Arrest

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Blood Lactate or Lactate Clearance: Which Is Robust to Predict the Neurological Outcomes after Cardiac Arrest? A Systematic Review and Meta-Analysis

BioMed Research International ◽

10.1155/2018/8014213 ◽

2018 ◽

Vol 2018 ◽

pp. 1-11 ◽

Cited By ~ 2

Author(s):

Bao-Chun Zhou ◽

Zheng Zhang ◽

Jian-Jun Zhu ◽

Li-Jun Liu ◽

Chun-Feng Liu

Keyword(s):

Systematic Review ◽

Cardiac Arrest ◽

Lactate Level ◽

Web Of Science ◽

Meta Analysis ◽

Surrogate Marker ◽

Lactate Clearance ◽

Time Points ◽

Neurological Outcomes ◽

Lactate Levels

Aims. Lactate and lactate clearance were supposed to be associated with cardiac arrest outcomes, but studies obtained different results. Thus, we conducted this meta-analysis to investigate the association between lactate or lactate clearance and neurological outcomes and their usefulness for prediction of neurological outcomes. Methods. We conducted a systematic search in PubMed, Web of science, EMBASE, Medline, and Google Scholar until May 1, 2018, for relevant studies. Studies reporting lactate, lactate clearance on admission, or other time points after admission associated with neurological outcomes were included in our analysis. Pooled effect date was shown as weighed mean difference (WMD) and 95% confidence interval (CI). To measure the usefulness of lactate on admission to predict neurological outcomes, we also pooled the data of diagnostic test. Results. 23 studies involving 6720 cardiac arrest (CA) patients were included. Results from our analysis indicated that patients with good neurological outcomes tended to have a lower lactate level on admission (WMD: -2.66 mmol/L, 95%CI: -3.39 to -1.93) and 12h, 24h, and 48h after admission (P<0.001). Furthermore, the pooled AUC for lactate level on admission to predict neurological outcomes was 0.77 (95%CI: 0.73-0.80). However, a significant association between lactate clearance and neurological outcomes was only found in 24h but not 12h lactate clearance rate. Conclusions. Lactate levels on admission and all time points up to 48h were associated with neurological outcomes after CA, whereas the association between lactate clearance and neurological outcomes was not so stable. Lactate was a more robust surrogate marker than lactate clearance to predict neurological outcomes after CA.

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The Association of Perioperative Serum Lactate Levels with Postoperative Delirium in Elderly Trauma Patients

BioMed Research International ◽

10.1155/2019/3963780 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Cheol Lee ◽

Juhwan Lee ◽

Hyunho Cho ◽

Jaekyeong Song ◽

Hojung Jung ◽

...

Keyword(s):

Lactate Level ◽

Postoperative Delirium ◽

Lactate Clearance ◽

Serum Lactate ◽

Trauma Patients ◽

Minor Trauma ◽

Serum Lactate Level ◽

Multivariable Analyses ◽

Lactate Levels ◽

Elderly Trauma Patients

Background. Several studies have shown the utility of lactate level as a predictor of early outcomes in trauma patients. We conducted this study to evaluate the association of perioperative serum lactate levels with postoperative delirium (POD) in elderly trauma patients. Materials and Methods. This study included 466 elderly trauma patients with measurements of serum lactate levels on admission and 1 h after surgery. The associations of POD with serum lactate levels (on admission and 1 h after surgery) and lactate clearance were analyzed using Kendall’s correlation. Perioperative serum lactate levels and lactate clearance as predictors of POD were evaluated using univariate and multivariable analyses. Results. The incidence of POD in the present study was 38.1%. Serum lactate levels on admission and at 1 h after surgery were significantly higher in major trauma than in minor trauma. In univariate analysis of perioperative serum lactate levels and lactate clearance as predictors of POD, the odds ratio (OR) for serum lactate level on admission was 4.19 (P<0.01, 2.91 < 95% confidence interval (CI) < 6.02) and that 1 h after surgery was 3.83 (P<0.01, 2.79 < 95% CI < 5.25); however, the OR for serum change of lactate level was 0.99 ((P<0.09, 0.99 < 95% CI < 1.00). In multivariable analysis for predictors of POD, the OR for serum lactate level on admission was 2.40 (P<0.09, 0.87 < 95% CI < 6.7), that for serum lactate 1 h after surgery was 2.83 (P=0.01, 1.28 < 95% CI < 6.24), that for ICU admission was 3.01 (P=0.01, 2.09 < 95% CI < 6.03), and that for ISS was 1.47 (P<0.01, 1.27 < 95% CI < 3.70). Conclusions. Taking together the results of univariate and multivariable analyses, serum lactate level 1 h after surgery may be used as a prediction model of POD development in elderly trauma patients.

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Abstract 24: Association Between Serum Lactate During Cardiopulmonary Resuscitation and Survival in Adult Out-Of-Hospital Cardiac Arrest: A Multicenter Cohort Study (The Critical Study in Osaka, Japan)

Circulation ◽

10.1161/circ.140.suppl_2.24 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Norihiro Nishioka ◽

Daisuke Kobayashi ◽

Junichi Izawa ◽

Takeyuki Kiguchi ◽

Tetsuhisa Kitamura ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Lactate Level ◽

Serum Lactate ◽

Critical Study ◽

Serum Lactate Level ◽

Shockable Rhythm ◽

Initial Rhythm ◽

Lactate Levels ◽

Hospital Cardiac Arrest

Background: Serum lactate reflects hypoxic insult in many conditions, but its role as prognostic markers after cardiac arrest is still controversial. This study aimed to investigate the association between serum lactate levels during cardiopulmonary resuscitation (CPR) and survival in patients with out-of-hospital cardiac arrest (OHCA). Methods: This study analyzed the data of the Osaka Comprehensive Registry of Intensive Care for OHCA Survival, a prospective multicenter observational study of 14 participating institutions in Osaka Prefecture, Japan. We enrolled consecutive patients aged ≥18 years who were transported to the hospital with ongoing CPR from 2013 to 2016. Based on the serum lactate levels, OHCA patients were divided into 4 quartiles: Q1 (lactate ≤10.6 mEq/L), Q2 (10.6< lactate ≤14.1 mEq/L), Q3 (14.1< lactate ≤18.0 mEq/L) and Q4 (lactate >18.0 mEq/L). The relationships between serum lactate level before return of spontaneous circulation (ROSC) and 1-month survival were assessed. Results: A total of 3,674 OHCA patients were included in the analysis. Overall 1-month survival was 2.3% (88/3,674). The Q1 group had the highest 1-month survival (4.6% [42/921]), followed by Q2 (2.7% [25/920]), Q3 (1.1% [11/966]) and Q4 (0.6% [5/867]), respectively (p for trend < 0.001). In the multivariable logistic regression analysis, the proportion of 1-month survival in the Q4 group was significantly lower, compared with that in the Q1 group (adjusted odds ratio 0.23; 95% confidence interval 0.09 to 0.60). The adjusted proportion of 1-month survival decreased in a stepwise manner across increasing quartiles (p for trend <0.001). In a subgroup analysis by initial rhythm, there was a significant interaction (p=0.003) between the rhythms: 1-month survival of OHCA patients presented with a non-shockable rhythm decreased when the lactate levels increased (p for trend < 0.001), but in patients with a shockable rhythm the similar trend was not observed (p for trend = 0.574). Conclusions: The high serum lactate level before ROSC significantly associated with the worse 1-month survival after OHCA. Serum lactate may be one of the effective prognostic indications for OHCA during CPR, especially with non-shockable initial rhythm.

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