J Düring1, J Dankiewicz2, T Cronberg3, C Hassager4, J Hovdenes5, J Kjaergaard4, M Kuiper6, N Nielsen7, T Pellis8, P Stammet9, J Vulto10, M Wanscher11, M Wise12, A Åneman13,14,15, H Friberg1. 1. Department of Clinical Sciences, Intensive and Perioperative Care, Lund University, Skane University Hospital, Malmö, Sweden. 2. Department of Clinical Sciences, Cardiology, Lund University, Skane University Hospital, Lund, Sweden. 3. Department of Clinical Sciences, Neurology, Lund University, Skane University Hospital, Lund, Sweden. 4. Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. 5. Division of Emergencies and Critical Care, Department of Anesthesiology, Oslo University Hospital Rikshospitalet, Oslo, Norway. 6. Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, The Netherlands. 7. Department of Clinical Sciences, Department of Anesthesiology and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden. 8. Department of Anaesthesia and Intensive Care, Azienda Ospedaliera 'Card. G. Panico', Tricase, Italy. 9. Medical Department, National Rescue Services, Luxembourg City, Luxembourg. 10. Department of Emergency Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands. 11. Department of Cardiothoracic Anaesthesia 4142, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. 12. Department of Adult Critical Care, University Hospital of Wales, Cardiff, UK. 13. Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sidney, NSW, Australia. 14. South Western Clinical School, University of New South Wales, Sydney, NSW, Australia. 15. The Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.
Abstract
BACKGROUND:Admission lactate and lactate clearance are implemented for risk stratification in sepsis and trauma. In out-of-hospital cardiac arrest, results regarding outcome and lactate are conflicting. METHODS: This is a post-hoc analysis of the Target Temperature Management trial in which 950 unconscious patents after out-of-hospital cardiac arrest were randomized to a temperature intervention of 33°C or 36°C. Serial lactate samples during the first 36 hours were collected. Admission lactate, 12-hour lactate, and the clearance of lactate within 12 hours after admission were analyzed and the association with 30-day mortality assessed. RESULTS: Samples from 877 patients were analyzed. In univariate logistic regression analysis, the odds ratio for death by day 30 for each mmol/L was 1.12 (1.08-1.16) for admission lactate, P < .01, 1.21 (1.12-1.31) for 12-hour lactate, P < .01, and 1.003 (1.00-1.01) for each percentage point increase in 12-hour lactate clearance, P = .03. Only admission lactate and 12-hour lactate levels remained significant after adjusting for known predictors of outcome. The area under the receiver operating characteristic curve was 0.65 (0.61-0.69), P < .001, 0.61 (0.57-0.65), P < .001, and 0.53 (0.49-0.57), P = .15 for admission lactate, 12-hour lactate, and 12-hour lactate clearance, respectively. CONCLUSIONS:Admission lactate and 12-hour lactate values were independently associated with 30-day mortality after out-of-hospital cardiac arrest while 12-hour lactate clearance was not. The clinical value of lactate as the sole predictor of outcome after out-of-hospital cardiac arrest is, however, limited.
RCT Entities:
BACKGROUND: Admission lactate and lactate clearance are implemented for risk stratification in sepsis and trauma. In out-of-hospital cardiac arrest, results regarding outcome and lactate are conflicting. METHODS: This is a post-hoc analysis of the Target Temperature Management trial in which 950 unconscious patents after out-of-hospital cardiac arrest were randomized to a temperature intervention of 33°C or 36°C. Serial lactate samples during the first 36 hours were collected. Admission lactate, 12-hour lactate, and the clearance of lactate within 12 hours after admission were analyzed and the association with 30-day mortality assessed. RESULTS: Samples from 877 patients were analyzed. In univariate logistic regression analysis, the odds ratio for death by day 30 for each mmol/L was 1.12 (1.08-1.16) for admission lactate, P < .01, 1.21 (1.12-1.31) for 12-hour lactate, P < .01, and 1.003 (1.00-1.01) for each percentage point increase in 12-hour lactate clearance, P = .03. Only admission lactate and 12-hour lactate levels remained significant after adjusting for known predictors of outcome. The area under the receiver operating characteristic curve was 0.65 (0.61-0.69), P < .001, 0.61 (0.57-0.65), P < .001, and 0.53 (0.49-0.57), P = .15 for admission lactate, 12-hour lactate, and 12-hour lactate clearance, respectively. CONCLUSIONS: Admission lactate and 12-hour lactate values were independently associated with 30-day mortality after out-of-hospital cardiac arrest while 12-hour lactate clearance was not. The clinical value of lactate as the sole predictor of outcome after out-of-hospital cardiac arrest is, however, limited.
Authors: Seung Ha Son; Yong Nam In; Jung Soo Park; Yeonho You; Jin Hong Min; Insool Yoo; Yong Chul Cho; Wonjoon Jeong; Hong Joon Ahn; Changshin Kang; Byung Kook Lee Journal: Neurocrit Care Date: 2021-01-11 Impact factor: 3.210