Clinical significance of lactate clearance in patients with cardiogenic shock: results from the RESCUE registry

Ik Hyun Park, Jeong Hoon Yang, Woo Jin Jang, Woo Jung Chun, Ju Hyeon Oh, Yong Hwan Park, Young-Guk Ko, Cheol Woong Yu, Bum Sung Kim, Hyun-Joong Kim, Hyun Jong Lee, Jin-Ok Jeong, Hyeon-Cheol Gwon, Ik Hyun Park, Jeong Hoon Yang, Woo Jin Jang, Woo Jung Chun, Ju Hyeon Oh, Yong Hwan Park, Young-Guk Ko, Cheol Woong Yu, Bum Sung Kim, Hyun-Joong Kim, Hyun Jong Lee, Jin-Ok Jeong, Hyeon-Cheol Gwon

Abstract

Background: Limited data are available on the clinical significance of lactate clearance (LC) in patients with cardiogenic shock (CS). This study investigated the prognostic role of LC in CS patients.

Methods: We analyzed data from 628 patients in the RESCUE registry, a multicenter, observational cohort enrolled between January 2014 and December 2018. Univariable logistic regression analysis was performed to determine the prognostic implications of 24 h LC, and then patients were divided into two groups according to the cut-off value of 24 h LC (high lactate clearance [HLC] group vs. low lactate clearance [LLC] group). The primary outcome was in-hospital mortality. We also assessed all-cause mortality at 12 month follow-up and compared the prognostic performance of 24 h LC according to initial serum lactate level.

Results: In the univariable logistic regression analysis, 24 h LC was associated with in-hospital mortality (odds ratio 0.989, 95% confidence interval [CI] 0.985-0.993, p < 0.001), and the cut-off value for the LC of the study population was 64%. The HLC group (initial 24 h LC ≥ 64%, n = 333) had a significantly lower incidence of in-hospital death than the LLC group (n = 295) (25.5% in the HLC group vs. 42.7% in the LLC group, p < 0.001). During 12 months of follow-up, the cumulative incidence of all-cause death was significantly lower in the HLC group than in the LLC group (33.0% vs. 48.8%; hazard ratio 0.55; 95% CI 0.42-0.70; p < 0.001). In subgroup analysis, 24 h LC predicted in-hospital mortality better in patients with initial serum lactate > 5 mmol/L than in those with serum lactate ≤ 5 mmol/L (c-statistics of initial serum lactate > 5 mmol/L = 0.782 vs. c-statistics of initial serum lactate ≤ 5 mmol/L = 0.660, p = 0.011).

Conclusions: Higher LC during the early phase of CS was associated with reduced risk of in-hospital and 12 month all-cause mortalities. Patients with LC ≥ 64% during the 24 h after CS onset could expect a favorable prognosis, especially those with an initial serum lactate > 5 mmol/L.

Trial registration: RESCUE (REtrospective and prospective observational Study to investigate Clinical oUtcomes and Efficacy of left ventricular assist device for Korean patients with cardiogenic shock), NCT02985008, Registered December 5, 2016-retrospectively and prospectively registered, https://ichgcp.net/clinical-trials-registry/NCT02985008.

Keywords: Cardiogenic shock; Lactate clearance; Prognosis.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Schematic illustration of study cohort selection
Fig. 2
Fig. 2
The cumulative incidence of all-cause mortality during 12 month follow-up according to lactate clearance. Kaplan–Meier curves are presented to compare the cumulative incidence of all-cause mortality between the low lactate clearance group and the high lactate clearance group. CI confidence interval, HR hazard ratio
Fig. 3
Fig. 3
ROC curves of lactate clearance to predict in-hospital mortality according to initial serum lactate level. ROC curves show the comparison of 24 h lactate clearance to predict in-hospital mortality according to initial serum lactate level > 5 mmol/L or not. AUC area under the curve, ROC receiver operating characteristic

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