Lactate versus Phosphate as Biomarkers to Aid Mechanical Circulatory Support Decisions in Patients with Out-of-Hospital Cardiac Arrest and Return of Spontaneous Circulation
Aims: Identifying patients who may benefit from mechanical circulatory support (MCS) after out-of-hospital cardiac arrest (OHCA) and return of spontaneous circulation (ROSC) remains challenging; thus, a search for helpful biomarkers is warranted. We aimed to evaluate phosphate and lactate levels on...
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MDPI AG
2023-04-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/13/9/1523 |
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| author | Dragos Andrei Duse Fabian Voß Laura Heyng Georg Wolff Christine Quast Daniel Scheiber Patrick Horn Malte Kelm Ralf Westenfeld Christian Jung Ralf Erkens |
| author_facet | Dragos Andrei Duse Fabian Voß Laura Heyng Georg Wolff Christine Quast Daniel Scheiber Patrick Horn Malte Kelm Ralf Westenfeld Christian Jung Ralf Erkens |
| author_sort | Dragos Andrei Duse |
| collection | DOAJ |
| description | Aims: Identifying patients who may benefit from mechanical circulatory support (MCS) after out-of-hospital cardiac arrest (OHCA) and return of spontaneous circulation (ROSC) remains challenging; thus, a search for helpful biomarkers is warranted. We aimed to evaluate phosphate and lactate levels on admission regarding their associations with survival with and without MCS. Methods: In 224 OHCA patients who achieved ROSC, the initial phosphate and lactate levels were investigated to discriminate in-hospital mortality by receiver operating characteristic (ROC) curves. According to the Youden Index (YI) from the respective ROC, the groups were risk stratified by both biomarkers, and 30-day mortality was analyzed in patients with and without MCS. Results: Within the entire collective, MCS was not associated with a better chance of survival. Both phosphate and lactate level elevations showed good yet comparable discriminations to predict mortality (areas under the curve: 0.80 vs. 0.79, <i>p</i> = 0.74). In patients with initial phosphate values > 2.2 mmol/L (>YI), 30-day mortality within the MCS cohort was lower (HR 2.3, 95% CI: 1.4–3.7; <i>p</i> = 0.0037). In patients with lower phosphate levels and groups stratified by lactate, 30-day mortality was similar in patients with and without MCS. Conclusions: We found a significant association between survival and MCS therapy in patients with phosphate levels above 2.2 mmol/L (Youden Index), and a similar discrimination of patient overall survival by lactate and phosphate. Prospective studies should assess the possible independent prognostic value of phosphate and its clearance for MCS efficiency. |
| first_indexed | 2024-03-11T04:21:24Z |
| format | Article |
| id | doaj.art-ac9a4e2acc1e4ab1bd74e6e8a93847bc |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-11T04:21:24Z |
| publishDate | 2023-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-ac9a4e2acc1e4ab1bd74e6e8a93847bc2023-11-17T22:44:50ZengMDPI AGDiagnostics2075-44182023-04-01139152310.3390/diagnostics13091523Lactate versus Phosphate as Biomarkers to Aid Mechanical Circulatory Support Decisions in Patients with Out-of-Hospital Cardiac Arrest and Return of Spontaneous CirculationDragos Andrei Duse0Fabian Voß1Laura Heyng2Georg Wolff3Christine Quast4Daniel Scheiber5Patrick Horn6Malte Kelm7Ralf Westenfeld8Christian Jung9Ralf Erkens10Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, GermanyDepartment of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, GermanyDepartment of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, GermanyDepartment of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, GermanyDepartment of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, GermanyDepartment of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, GermanyDepartment of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, GermanyDepartment of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, GermanyDepartment of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, GermanyDepartment of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, GermanyDepartment of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, GermanyAims: Identifying patients who may benefit from mechanical circulatory support (MCS) after out-of-hospital cardiac arrest (OHCA) and return of spontaneous circulation (ROSC) remains challenging; thus, a search for helpful biomarkers is warranted. We aimed to evaluate phosphate and lactate levels on admission regarding their associations with survival with and without MCS. Methods: In 224 OHCA patients who achieved ROSC, the initial phosphate and lactate levels were investigated to discriminate in-hospital mortality by receiver operating characteristic (ROC) curves. According to the Youden Index (YI) from the respective ROC, the groups were risk stratified by both biomarkers, and 30-day mortality was analyzed in patients with and without MCS. Results: Within the entire collective, MCS was not associated with a better chance of survival. Both phosphate and lactate level elevations showed good yet comparable discriminations to predict mortality (areas under the curve: 0.80 vs. 0.79, <i>p</i> = 0.74). In patients with initial phosphate values > 2.2 mmol/L (>YI), 30-day mortality within the MCS cohort was lower (HR 2.3, 95% CI: 1.4–3.7; <i>p</i> = 0.0037). In patients with lower phosphate levels and groups stratified by lactate, 30-day mortality was similar in patients with and without MCS. Conclusions: We found a significant association between survival and MCS therapy in patients with phosphate levels above 2.2 mmol/L (Youden Index), and a similar discrimination of patient overall survival by lactate and phosphate. Prospective studies should assess the possible independent prognostic value of phosphate and its clearance for MCS efficiency.https://www.mdpi.com/2075-4418/13/9/1523phosphatemechanical-circulatory-supportout-of-hospital cardiac arrestsurvivalROSC |
| spellingShingle | Dragos Andrei Duse Fabian Voß Laura Heyng Georg Wolff Christine Quast Daniel Scheiber Patrick Horn Malte Kelm Ralf Westenfeld Christian Jung Ralf Erkens Lactate versus Phosphate as Biomarkers to Aid Mechanical Circulatory Support Decisions in Patients with Out-of-Hospital Cardiac Arrest and Return of Spontaneous Circulation Diagnostics phosphate mechanical-circulatory-support out-of-hospital cardiac arrest survival ROSC |
| title | Lactate versus Phosphate as Biomarkers to Aid Mechanical Circulatory Support Decisions in Patients with Out-of-Hospital Cardiac Arrest and Return of Spontaneous Circulation |
| title_full | Lactate versus Phosphate as Biomarkers to Aid Mechanical Circulatory Support Decisions in Patients with Out-of-Hospital Cardiac Arrest and Return of Spontaneous Circulation |
| title_fullStr | Lactate versus Phosphate as Biomarkers to Aid Mechanical Circulatory Support Decisions in Patients with Out-of-Hospital Cardiac Arrest and Return of Spontaneous Circulation |
| title_full_unstemmed | Lactate versus Phosphate as Biomarkers to Aid Mechanical Circulatory Support Decisions in Patients with Out-of-Hospital Cardiac Arrest and Return of Spontaneous Circulation |
| title_short | Lactate versus Phosphate as Biomarkers to Aid Mechanical Circulatory Support Decisions in Patients with Out-of-Hospital Cardiac Arrest and Return of Spontaneous Circulation |
| title_sort | lactate versus phosphate as biomarkers to aid mechanical circulatory support decisions in patients with out of hospital cardiac arrest and return of spontaneous circulation |
| topic | phosphate mechanical-circulatory-support out-of-hospital cardiac arrest survival ROSC |
| url | https://www.mdpi.com/2075-4418/13/9/1523 |
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