The lactate clearance calculated using serum lactate level 6 h after is an important prognostic predictor after extracorporeal cardiopulmonary resuscitation: a single-center retrospective observational study
Abstract Background Serum lactate level can predict clinical outcomes in some critical cases. In the clinical setting, we noted that patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) and with poor serum lactate improvement often do not recover from cardiopulmonary arrest. There...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-06-01
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| Series: | Journal of Intensive Care |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s40560-018-0302-z |
| _version_ | 1811221007697969152 |
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| author | Takashi Mizutani Norio Umemoto Toshio Taniguchi Hideki Ishii Yuri Hiramatsu Koji Arata Horagaito Takuya Sho Inoue Tsuyoshi Sugiura Toru Asai Michiharu Yamada Toyoaki Murohara Kiyokazu Shimizu |
| author_facet | Takashi Mizutani Norio Umemoto Toshio Taniguchi Hideki Ishii Yuri Hiramatsu Koji Arata Horagaito Takuya Sho Inoue Tsuyoshi Sugiura Toru Asai Michiharu Yamada Toyoaki Murohara Kiyokazu Shimizu |
| author_sort | Takashi Mizutani |
| collection | DOAJ |
| description | Abstract Background Serum lactate level can predict clinical outcomes in some critical cases. In the clinical setting, we noted that patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) and with poor serum lactate improvement often do not recover from cardiopulmonary arrest. Therefore, we investigated the association between lactate clearance and in-hospital mortality in cardiac arrest patients undergoing ECPR. Methods Serum lactate levels were measured on admission and every hour after starting ECPR. Lactate clearance [(lactate at first measurement − lactate 6 h after)/lactate at first measurement × 100] was calculated 6 h after first serum lactate measurement. All patients who underwent ECPR were registered retrospectively using opt-out in our outpatient’s segment. Result In this retrospective study, 64 cases were evaluated, and they were classified into two groups according to lactate clearance: high-clearance group, > 65%; low-clearance group, ≤ 65%. Surviving discharge rate of high-clearance group (12 cases, 63%) is significantly higher than that of low-clearance group (11 cases, 24%) (p < 0.01). Considering other confounders, lactate clearance was an independent predictor for in-hospital mortality (odds ratio, 7.10; 95% confidence interval, 1.71–29.5; p < 0.01). Both net reclassification improvement (0.64, p < 0.01) and integrated reclassification improvement (0.12, p < 0.01) show that adding lactate clearance on established risk factors improved the predictability of in-hospital mortality. Conclusion In our study, lactate clearance calculated through arterial blood gas analysis 6 h after ECPR was one of the most important predictors of in-hospital mortality in patients treated with ECPR after cardiac arrest. |
| first_indexed | 2024-04-12T07:52:28Z |
| format | Article |
| id | doaj.art-8f4d3ae7065745468182c717232c5842 |
| institution | Directory Open Access Journal |
| issn | 2052-0492 |
| language | English |
| last_indexed | 2024-04-12T07:52:28Z |
| publishDate | 2018-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Intensive Care |
| spelling | doaj.art-8f4d3ae7065745468182c717232c58422022-12-22T03:41:34ZengBMCJournal of Intensive Care2052-04922018-06-01611710.1186/s40560-018-0302-zThe lactate clearance calculated using serum lactate level 6 h after is an important prognostic predictor after extracorporeal cardiopulmonary resuscitation: a single-center retrospective observational studyTakashi Mizutani0Norio Umemoto1Toshio Taniguchi2Hideki Ishii3Yuri Hiramatsu4Koji Arata5Horagaito Takuya6Sho Inoue7Tsuyoshi Sugiura8Toru Asai9Michiharu Yamada10Toyoaki Murohara11Kiyokazu Shimizu12Cardiovascular Center, Ichinomiya Municipal HospitalCardiovascular Center, Ichinomiya Municipal HospitalDepartment of Emergency, Ichinomiya Municipal HospitalDepartment of Cardiology, Nagoya University Graduate School of MedicineCardiovascular Center, Ichinomiya Municipal HospitalDepartment of Medical Engineering, Ichinomiya Municipal HospitalDepartment of Medical Engineering, Ichinomiya Municipal HospitalDepartment of Emergency, Ichinomiya Municipal HospitalCardiovascular Center, Ichinomiya Municipal HospitalCardiovascular Center, Ichinomiya Municipal HospitalCardiovascular Center, Ichinomiya Municipal HospitalDepartment of Cardiology, Nagoya University Graduate School of MedicineCardiovascular Center, Ichinomiya Municipal HospitalAbstract Background Serum lactate level can predict clinical outcomes in some critical cases. In the clinical setting, we noted that patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) and with poor serum lactate improvement often do not recover from cardiopulmonary arrest. Therefore, we investigated the association between lactate clearance and in-hospital mortality in cardiac arrest patients undergoing ECPR. Methods Serum lactate levels were measured on admission and every hour after starting ECPR. Lactate clearance [(lactate at first measurement − lactate 6 h after)/lactate at first measurement × 100] was calculated 6 h after first serum lactate measurement. All patients who underwent ECPR were registered retrospectively using opt-out in our outpatient’s segment. Result In this retrospective study, 64 cases were evaluated, and they were classified into two groups according to lactate clearance: high-clearance group, > 65%; low-clearance group, ≤ 65%. Surviving discharge rate of high-clearance group (12 cases, 63%) is significantly higher than that of low-clearance group (11 cases, 24%) (p < 0.01). Considering other confounders, lactate clearance was an independent predictor for in-hospital mortality (odds ratio, 7.10; 95% confidence interval, 1.71–29.5; p < 0.01). Both net reclassification improvement (0.64, p < 0.01) and integrated reclassification improvement (0.12, p < 0.01) show that adding lactate clearance on established risk factors improved the predictability of in-hospital mortality. Conclusion In our study, lactate clearance calculated through arterial blood gas analysis 6 h after ECPR was one of the most important predictors of in-hospital mortality in patients treated with ECPR after cardiac arrest.http://link.springer.com/article/10.1186/s40560-018-0302-zLactate clearanceExtracorporeal cardiopulmonary resuscitationCardiac arrestIn-hospital mortality |
| spellingShingle | Takashi Mizutani Norio Umemoto Toshio Taniguchi Hideki Ishii Yuri Hiramatsu Koji Arata Horagaito Takuya Sho Inoue Tsuyoshi Sugiura Toru Asai Michiharu Yamada Toyoaki Murohara Kiyokazu Shimizu The lactate clearance calculated using serum lactate level 6 h after is an important prognostic predictor after extracorporeal cardiopulmonary resuscitation: a single-center retrospective observational study Journal of Intensive Care Lactate clearance Extracorporeal cardiopulmonary resuscitation Cardiac arrest In-hospital mortality |
| title | The lactate clearance calculated using serum lactate level 6 h after is an important prognostic predictor after extracorporeal cardiopulmonary resuscitation: a single-center retrospective observational study |
| title_full | The lactate clearance calculated using serum lactate level 6 h after is an important prognostic predictor after extracorporeal cardiopulmonary resuscitation: a single-center retrospective observational study |
| title_fullStr | The lactate clearance calculated using serum lactate level 6 h after is an important prognostic predictor after extracorporeal cardiopulmonary resuscitation: a single-center retrospective observational study |
| title_full_unstemmed | The lactate clearance calculated using serum lactate level 6 h after is an important prognostic predictor after extracorporeal cardiopulmonary resuscitation: a single-center retrospective observational study |
| title_short | The lactate clearance calculated using serum lactate level 6 h after is an important prognostic predictor after extracorporeal cardiopulmonary resuscitation: a single-center retrospective observational study |
| title_sort | lactate clearance calculated using serum lactate level 6 h after is an important prognostic predictor after extracorporeal cardiopulmonary resuscitation a single center retrospective observational study |
| topic | Lactate clearance Extracorporeal cardiopulmonary resuscitation Cardiac arrest In-hospital mortality |
| url | http://link.springer.com/article/10.1186/s40560-018-0302-z |
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