Association Between the Acidemia, Lactic Acidosis, and Shock Severity With Outcomes in Patients With Cardiogenic Shock

Background Lactic acidosis is associated with mortality in patients with cardiogenic shock (CS). Elevated lactate levels and systemic acidemia (low blood pH) have both been proposed as drivers of death. We, therefore, analyzed the association of both high lactate concentrations and low blood pH with...

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Published in:Journal of the American Heart Association 2022-05, Vol.11 (9), p.e024932-e024932
Main Authors: Jentzer, Jacob C, Schrage, Benedikt, Patel, Parag C, Kashani, Kianoush B, Barsness, Gregory W, Holmes, Jr, David R, Blankenberg, Stefan, Kirchhof, Paulus, Westermann, Dirk
Format: Article
Language:English
Subjects:
acidemia
Acidosis
Acidosis, Lactic - complications
Acidosis, Lactic - diagnosis
Aged
cardiogenic shock
Cohort Studies
Female
Humans
Lactic Acid
lactic acidosis
Male
Original Research
shock
Shock - etiology
Shock, Cardiogenic - diagnosis
Shock, Cardiogenic - etiology
Shock, Cardiogenic - therapy
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Summary:Background Lactic acidosis is associated with mortality in patients with cardiogenic shock (CS). Elevated lactate levels and systemic acidemia (low blood pH) have both been proposed as drivers of death. We, therefore, analyzed the association of both high lactate concentrations and low blood pH with 30-day mortality in patients with CS. Methods and Results This was a 2-center historical cohort study of unselected patients with CS with available data for admission lactate level or blood pH. CS severity was graded using the Society for Cardiovascular Angiography and Intervention (SCAI) shock classification. All-cause survival at 30 days was analyzed using Kaplan-Meier curves and Cox proportional-hazards analysis. There were 1814 patients with CS (mean age, 67.3 years; 68.5% men); 51.8% had myocardial infarction and 53.0% had cardiac arrest. The distribution of SCAI shock stages was B, 10.8%; C, 30.7%; D, 38.1%; and E, 18.7%. In both cohorts, higher lactate or lower pH predicted a higher risk of adjusted 30-day mortality. Patients with a lactate ≥5 mmol/L or pH
ISSN:2047-9980
2047-9980
DOI:10.1161/JAHA.121.024932