Prognostic Impact of Early Lactate Trajectory Among Patients Admitted with Cardiogenic Shock
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Background
The importance of lactate trajectory during the first day of cardiogenic shock is increasingly recognized. We aimed to assess the association between admission-day lactate trajectory and in-hospital mortality, and to identify same-day interventions predictive of lactate clearance.
Methods
We analyzed adult patients admitted with cardiogenic shock between October 2015 and June 2023, using the Vizient® Clinical Data Base. Early lactate clearance was defined as lactate <2.5 mmol/L by the end of the admission day. We used multivariable logistic regression to assess the association between lactate change and in-hospital mortality, and to identify interventions associated with lactate clearance.
Results
Among 40,434 patients with cardiogenic shock, 30.1% achieved same-day lactate normalization, which was associated with lower in-hospital mortality (aOR 0.51; 95% CI 0.48–0.54). Lactate change showed the greatest prognostic importance, with observed mortality exceeding 80% among those with lactate increase >5 mmol/L regardless of baseline values. After adjustment, lactate change showed a positive exponential relationship with mortality, with aORs ranging from 0.25 (95% CI 0.23–0.27) for a -10 mmol/L change to 3.99 (95% CI 3.58–4.40) for a +10 mmol/L change. The intervention most strongly associated with early lactate clearance was pulmonary artery catheter (PAC; aOR 1.28 [95% CI 1.19–1.37]).
Conclusions
Nearly 1 in 3 patients with cardiogenic shock achieved early lactate clearance, which was associated with lower mortality. The magnitude of lactate change had profound prognostic implications regardless of the initial value. Among day 1 interventions, PAC use had the strongest association with lactate clearance.
CLINICAL PERSPECTIVE
What is new?
In this real-world cohort of patients with cardiogenic shock, nearly 1 in 3 achieved normal lactate values on the first day of admission.
Early lactate clearance was associated with nearly half the odds of in-hospital death, but the magnitude of lactate change on admission day had the strongest prognostic value regardless of the initial lactate value.
The intervention on the first day of admission most associated with early lactate clearance was pulmonary artery catheterization placement.
What are the clinical implications?
Both the normalization of and magnitude of change in lactate on the first day of admission offer prognostic information that can help guide risk stratification in patients with cardiogenic shock.
Our findings are further support for the importance of early trajectory in patients with cardiogenic shock and highlight the importance of lactate trends in that assessment.
