Arterial Lactate in Cardiogenic Shock: Prognostic Value of Clearance Versus Single Values

• Published in: JACC. Cardiovascular interventions 2020-10, Vol.13 (19), p.2208-2216
• Main Authors: Fuernau, Georg, Desch, Steffen, de Waha-Thiele, Suzanne, Eitel, Ingo, Neumann, Franz-Josef, Hennersdorf, Marcus, Felix, Stephan B, Fach, Andreas, Böhm, Michael, Pöss, Janine, Jung, Christian, Ouarrak, Taoufik, Schneider, Steffen, Werdan, Karl, Zeymer, Uwe, Thiele, Holger
• Format: Article
• Language: English
• ISSN: 1876-7605
• DOI: 10.1016/j.jcin.2020.06.037

This study sought to compare single lactate values at admission (L1) and after 8 h (L2) with lactate clearance (LC) for mortality prediction in cardiogenic shock (CS). Early estimation of prognosis in CS complicating acute myocardial infarction is crucial for tailored treatment selection. Arterial lactate is the most widely used point-of-care parameter in CS. In septic shock, lactate reduction over time-LC-has been extensively investigated. However, in CS, only limited data exist, and the prognostic value of LC is unknown. This study is a subanalysis of the IABP-SHOCK II (Intraaortic Balloon Pump in Cardiogenic Shock II) trial and the corresponding registry. Lactate levels were prospectively collected. All-cause mortality at 30 days was assessed as primary endpoint. For 671 of 783 (85.7%) patients, L1 and L2 values were available. The area under the receiver-operating characteristic curve (L1: 0.69; L2: 0.76; LC: 0.59) showed no difference between L1 and LC (p = 0.20). In contrast, L2 was a significantly better predictive parameter than L1 or LC (p