Normalized lactate load as an independent prognostic indicator in patients with cardiogenic shock.

BACKGROUND: Early prognosis evaluation is crucial for decision-making in cardiogenic shock (CS) patients. Dynamic lactate assessment, for example, normalized lactate load, has been a better prognosis predictor than single lactate value in septic shock. Our objective was to investigate the correlation between normalized lactate load and in-hospital mortality in patients with CS. METHODS: Data were extracted from the Medical Information Mart for Intensive Care (MIMIC)-IV database. The calculation of lactate load involved the determination of the cumulative area under the lactate curve, while normalized lactate load was computed by dividing the lactate load by the corresponding period. Receiver Operating Characteristic (ROC) curves were constructed, and the evaluation of areas under the curves (AUC) for various parameters was performed using the DeLong test. RESULTS: Our study involved a cohort of 1932 CS patients, with 687 individuals (36.1%) experiencing mortality during their hospitalization. The AUC for normalized lactate load demonstrated significant superiority compared to the first lactate (0.675 vs. 0.646, P < 0.001), maximum lactate (0.675 vs. 0.651, P < 0.001), and mean lactate (0.675 vs. 0.669, P = 0.003). Notably, the AUC for normalized lactate load showed comparability to that of the Sequential Organ Failure Assessment (SOFA) score (0.675 vs. 0.695, P = 0.175). CONCLUSION: The normalized lactate load was an independently associated with the in-hospital mortality among CS patients.

Association between normalized lactate load and in-hospital mortality in patients with acute myocardial infarction.

BACKGROUND: Lactate was a prognostic indicator for acute myocardial infarction (AMI) patients. However, the association between normalized lactate load, representing hypoxic burden over time, and in-hospital mortality remained uncertain. METHODS: The data for this study was obtained from the Medical Information Mart for Intensive Care IV (MIMIC-IV, version 2.1) database. The normalized lactate load, describing the average intensity of hyperlactatemia, was calculated as the area under the curve (AUC) of lactate divided by time. 5882 AMI patients enrolled in this study were divided into survivor (n = 5015), and non-survivor group (n = 867). The primary endpoint was in-hospital mortality. Receiver operating characteristic (ROC) curves were generated to assess the predictive efficacy of normalized lactate load for in-hospital mortality, and areas under the curves of different parameters were compared using DeLong test. Multivariate binary logistic regression analysis was employed to explore the association between normalized lactate load and in-hospital mortality. The adjusting variables included age, gender, ethnicity, heart rate, systolic blood pressure, congestive heart failure, shock, dyslipidemia, cardiac arrest, cerebrovascular disease, neutrophil, lymphocyte, creatinine, blood nitrogen urea, clopidogrel, beta-blockers, angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB), statins, dialysis, extracorporeal membrane oxygenation (ECMO), the Sequential Organ Failure Assessment (SOFA) score and Simplified Acute Physiology Score II (SAPS II). Restricted cubic spline (RCS) was conducted to evaluate nonlinear associations of normalized lactate load with in-hospital mortality. RESULTS: The overall in-hospital mortality rate was 14.7%. After adjusting for confounding variables, normalized lactate load was independently associated with increased risk of in-hospital mortality (Normalized lactate load≥2.6 vs Normalized lactate load<2.6: OR, 95% CI: 1.56, 1.27-1.93). The RCS demonstrated a positive linear relationship between normalized lactate load and in-hospital mortality (non-linear p = 0.725). ROC curves showed that normalized lactate load was better than first lactate, maximum lactate, and mean lactate in predicting in-hospital mortality, but lower than SOFA and SAPS II. Among participants with at least nine lactate measures, normalized lactate load showed predictive performance comparable to SOFA and SAPS II. CONCLUSION: Normalized lactate load can be used to predict the prognosis of in-hospital mortality in AMI patients, and its prediction performance increases with the increase of lactate measurement.

Persistent Hyperlactatemia as the Predictor of Poor Outcome in Critically Ill Children: A Single-Center, Prospective, Observational Cohort Study.

Objective To study incidence of hyperlactatemia and its correlation with outcome in critically ill children. Design Single-center, prospective cohort study. Setting Eight-bedded PICU. Method Serial serum lactate levels were measured in 140 critically ill children at 0, 12, 24, and 48 hours. Results A total of 45% children had hyperlactatemia. Lactate levels were significantly ( p = 0.000) higher in nonsurvivors at all intervals. Lactate levels decreased significantly ( p = 0.000) in survivors while increased in nonsurvivors. Normalized lactate load was found to be an independent predictor of mortality ( p = 0.023). Conclusion Persistent hyperlactatemia serves as a possible predictor of poor outcome in critically ill children.