Use of serum lactate levels to predict survival for patients with out-of-hospital cardiac arrest: A cohort study.

OBJECTIVES: We examined the association of serum lactate levels and early lactate clearance with survival to hospital discharge for patients suffering an out-of-hospital cardiac arrest (OHCA). METHODS: A retrospective cohort analysis was performed of patients with OHCA transported by ambulance to two adult tertiary hospitals in Perth, Western Australia. Exclusion criteria were traumatic cardiac arrest, return of spontaneous circulation prior to the arrival of the ambulance, age less than 18 years and no serum lactate levels recorded. Serum lactate levels recorded for up to 48 h post-arrest were obtained from the hospital clinical information system, and lactate clearance over 48 h was calculated. Descriptive and logistic regression analyses were conducted. RESULTS: There were 518 patients with lactate values, of whom 126 (24.3%) survived to hospital discharge. Survivors and non-survivors had different mean initial lactate levels (mean ± SD 6.9 ± 4.7 and 12.2 ± 5.5 mmol/L, respectively; P < 0.001). Lactate clearance was higher in survivors. Lactate levels for non-survivors did not decrease below 2 mmol/L until at least 30 h after the ambulance call. CONCLUSION: In OHCA patients who had serum lactate levels measured, both lower initial serum lactate and early lactate clearance in the first 48 h following OHCA were associated with increased likelihood of survival. However, the use of lactate in isolation as a predictor of survival or neurological outcome is not recommended. Prospective studies that minimise selection bias are required to determine the clinical utility of serum lactate levels in OHCA patients.

Role of catalase overproduction in drug resistance and virulence in Candida albicans.

AIM: To investigate the role of Cat1 overproduction in Candida albicans. MATERIALS & METHODS: Strains overproducing the CAT1 gene were constructed. RESULTS: Cells overproducing CAT1 were found to be more resistant to some oxidants and mammalian phagocytic cells. They also showed reduced intracellular reactive oxygen species generated by amphotericin B or ciclopirox olamine. CAT1 overproduction did not change the minimum inhibitory concentration of fungal cells to fungistatic or fungicidal azoles nor to amphotericin B although increased twofold the minimum inhibitory concentration to caspofungin. The role of Cat1 overproduction in virulence and colonization was also analyzed in mouse models. CONCLUSION: The overproduction of Cat1 protects against oxidants, phagocytes and certain antifungals at subinhibitory concentration but does not increase virulence in a systemic infection mouse model.