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Association between lactate clearance during post-resuscitation care and neurologic outcome in cardiac arrest survivors treated with targeted temperature management

View Article: PubMed Central - PubMed

ABSTRACT

Objective: We investigated the association between lactate clearance or serum lactate levels and neurologic outcomes or in-hospital mortality in cardiac arrest survivors who were treated with targeted temperature management (TTM).

Methods: A retrospective analysis of data from cardiac arrest survivors treated with TTM between 2012 and 2015 was conducted. Serum lactate levels were measured on admission and at 12, 24, and 48 hours following admission. Lactate clearance at 12, 24, and 48 hours was also calculated. The primary outcome was neurologic outcome at discharge. The secondary outcome was in-hospital mortality.

Results: The study included 282 patients; 184 (65.2%) were discharged with a poor neurologic outcome, and 62 (22.0%) died. Higher serum lactate levels at 12 hours (odds ratio [OR], 1.157; 95% confidence interval [CI], 1.006 to 1.331), 24 hours (OR, 1.320; 95% CI, 1.084 to 1.607), and 48 hours (OR, 2.474; 95% CI, 1.459 to 4.195) after admission were associated with a poor neurologic outcome. Furthermore, a higher serum lactate level at 48 hours (OR, 1.459; 95% CI, 1.181 to 1.803) following admission was associated with in-hospital mortality. Lactate clearance was not associated with neurologic outcome or in-hospital mortality at any time point after adjusting for confounders.

Conclusion: Increased serum lactate levels after admission are associated with a poor neurologic outcome at discharge and in-hospital mortality in cardiac arrest survivors treated with TTM. Conversely, lactate clearance is not a robust surrogate marker of neurologic outcome or in-hospital mortality.

No MeSH data available.


Comparison of repeatedly measured serum lactate levels between outcome groups. (A) There was no interaction between neurologic outcome and time (P=0.318). Serum lactate levels decreased over time (P<0.001) and differed between the good and poor neurologic outcome groups (P<0.001). Post-hoc analysis adjusted with Bonferroni correction showed that the serum lactate levels at 12, 24, and 48 hours after admission were significantly different between the good and poor neurologic outcome groups. (B) There was no interaction between in-hospital mortality and time (P=0.444). Serum lactate levels differed between survivors and non-survivors (P=0.001). Post-hoc analysis adjusted with Bonferroni correction showed that the serum lactate level at 48 hours after admission was higher in non-survivors. *P<0.05.
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f2-ceem-16-149: Comparison of repeatedly measured serum lactate levels between outcome groups. (A) There was no interaction between neurologic outcome and time (P=0.318). Serum lactate levels decreased over time (P<0.001) and differed between the good and poor neurologic outcome groups (P<0.001). Post-hoc analysis adjusted with Bonferroni correction showed that the serum lactate levels at 12, 24, and 48 hours after admission were significantly different between the good and poor neurologic outcome groups. (B) There was no interaction between in-hospital mortality and time (P=0.444). Serum lactate levels differed between survivors and non-survivors (P=0.001). Post-hoc analysis adjusted with Bonferroni correction showed that the serum lactate level at 48 hours after admission was higher in non-survivors. *P<0.05.

Mentions: Serum lactate levels differed between neurologic outcome groups and decreased over time (P<0.001) with no interaction between neurologic outcome and time (P=0.318) (Fig. 2). Post-hoc analysis showed that serum lactate levels differed between neurologic outcome groups at 12, 24, and 48 hours after admission (Fig. 2). Lactate clearance at all time points differed between the good and poor neurologic outcome groups (Fig. 3). Serum lactate levels also differed between survivors and non-survivors and decreased over time (P<0.001), with no interaction between in-hospital mortality and time (P=0.444) (Fig. 2). Post-hoc analysis showed that serum lactate levels at 48 hours after admission differed between survivors and non-survivors (Fig. 2). Lactate clearance at 48 hours after admission was different between survivors and non-survivors (Fig. 3).


Association between lactate clearance during post-resuscitation care and neurologic outcome in cardiac arrest survivors treated with targeted temperature management
Comparison of repeatedly measured serum lactate levels between outcome groups. (A) There was no interaction between neurologic outcome and time (P=0.318). Serum lactate levels decreased over time (P<0.001) and differed between the good and poor neurologic outcome groups (P<0.001). Post-hoc analysis adjusted with Bonferroni correction showed that the serum lactate levels at 12, 24, and 48 hours after admission were significantly different between the good and poor neurologic outcome groups. (B) There was no interaction between in-hospital mortality and time (P=0.444). Serum lactate levels differed between survivors and non-survivors (P=0.001). Post-hoc analysis adjusted with Bonferroni correction showed that the serum lactate level at 48 hours after admission was higher in non-survivors. *P<0.05.
© Copyright Policy
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC5385509&req=5

f2-ceem-16-149: Comparison of repeatedly measured serum lactate levels between outcome groups. (A) There was no interaction between neurologic outcome and time (P=0.318). Serum lactate levels decreased over time (P<0.001) and differed between the good and poor neurologic outcome groups (P<0.001). Post-hoc analysis adjusted with Bonferroni correction showed that the serum lactate levels at 12, 24, and 48 hours after admission were significantly different between the good and poor neurologic outcome groups. (B) There was no interaction between in-hospital mortality and time (P=0.444). Serum lactate levels differed between survivors and non-survivors (P=0.001). Post-hoc analysis adjusted with Bonferroni correction showed that the serum lactate level at 48 hours after admission was higher in non-survivors. *P<0.05.
Mentions: Serum lactate levels differed between neurologic outcome groups and decreased over time (P<0.001) with no interaction between neurologic outcome and time (P=0.318) (Fig. 2). Post-hoc analysis showed that serum lactate levels differed between neurologic outcome groups at 12, 24, and 48 hours after admission (Fig. 2). Lactate clearance at all time points differed between the good and poor neurologic outcome groups (Fig. 3). Serum lactate levels also differed between survivors and non-survivors and decreased over time (P<0.001), with no interaction between in-hospital mortality and time (P=0.444) (Fig. 2). Post-hoc analysis showed that serum lactate levels at 48 hours after admission differed between survivors and non-survivors (Fig. 2). Lactate clearance at 48 hours after admission was different between survivors and non-survivors (Fig. 3).

View Article: PubMed Central - PubMed

ABSTRACT

Objective: We investigated the association between lactate clearance or serum lactate levels and neurologic outcomes or in-hospital mortality in cardiac arrest survivors who were treated with targeted temperature management (TTM).

Methods: A retrospective analysis of data from cardiac arrest survivors treated with TTM between 2012 and 2015 was conducted. Serum lactate levels were measured on admission and at 12, 24, and 48 hours following admission. Lactate clearance at 12, 24, and 48 hours was also calculated. The primary outcome was neurologic outcome at discharge. The secondary outcome was in-hospital mortality.

Results: The study included 282 patients; 184 (65.2%) were discharged with a poor neurologic outcome, and 62 (22.0%) died. Higher serum lactate levels at 12 hours (odds ratio [OR], 1.157; 95% confidence interval [CI], 1.006 to 1.331), 24 hours (OR, 1.320; 95% CI, 1.084 to 1.607), and 48 hours (OR, 2.474; 95% CI, 1.459 to 4.195) after admission were associated with a poor neurologic outcome. Furthermore, a higher serum lactate level at 48 hours (OR, 1.459; 95% CI, 1.181 to 1.803) following admission was associated with in-hospital mortality. Lactate clearance was not associated with neurologic outcome or in-hospital mortality at any time point after adjusting for confounders.

Conclusion: Increased serum lactate levels after admission are associated with a poor neurologic outcome at discharge and in-hospital mortality in cardiac arrest survivors treated with TTM. Conversely, lactate clearance is not a robust surrogate marker of neurologic outcome or in-hospital mortality.

No MeSH data available.