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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.


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Multivariate logistic regression model showing the association between lactate clearance and outcomes. (A) Lactate clearance at 12, 24, and 48 hours after admission was not associated with neurologic outcome. (B) Lactate clearance at 12, 24, and 48 hours after admission was not associated with in-hospital mortality. CI, confidence interval.
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f4-ceem-16-149: Multivariate logistic regression model showing the association between lactate clearance and outcomes. (A) Lactate clearance at 12, 24, and 48 hours after admission was not associated with neurologic outcome. (B) Lactate clearance at 12, 24, and 48 hours after admission was not associated with in-hospital mortality. CI, confidence interval.

Mentions: Multivariate analysis revealed that an older age, non-shockable rhythm, non-cardiac etiology, longer downtime, and a lower GCS score were associated with a poor neurologic outcome (Table 3). Serum lactate levels at various time points were separated into different multivariate models. 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, whereas lactate level on admission (OR, 1.049; 95% CI, 0.962 to 1.143) was not associated with neurologic outcome (Table 3). Furthermore, lactate clearance was not associated with neurologic outcome at any time point (Fig. 4). Multivariate analysis revealed that a non-shockable rhythm and the SOFA score were associated with in-hospital mortality (Table 4). A higher lactate level at 48 hours (OR, 1.459; 95% CI, 1.181 to 1.803) after admission was associated with an increased in-hospital mortality, whereas the lactate level on admission (OR, 1.063; 95% CI, 0.981 to 1.152) and the lactate levels at 12 hours (OR, 1.031; 95% CI, 0.928 to 1.146) and 24 hours (OR, 1.024; 95% CI, 0.940 to 1.116) after admission were not associated with in-hospital mortality (Table 4). Additionally, lactate clearance was not associated with in-hospital mortality at any time point (Fig. 4).


Association between lactate clearance during post-resuscitation care and neurologic outcome in cardiac arrest survivors treated with targeted temperature management
Multivariate logistic regression model showing the association between lactate clearance and outcomes. (A) Lactate clearance at 12, 24, and 48 hours after admission was not associated with neurologic outcome. (B) Lactate clearance at 12, 24, and 48 hours after admission was not associated with in-hospital mortality. CI, confidence interval.
© Copyright Policy
Related In: Results  -  Collection

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

f4-ceem-16-149: Multivariate logistic regression model showing the association between lactate clearance and outcomes. (A) Lactate clearance at 12, 24, and 48 hours after admission was not associated with neurologic outcome. (B) Lactate clearance at 12, 24, and 48 hours after admission was not associated with in-hospital mortality. CI, confidence interval.
Mentions: Multivariate analysis revealed that an older age, non-shockable rhythm, non-cardiac etiology, longer downtime, and a lower GCS score were associated with a poor neurologic outcome (Table 3). Serum lactate levels at various time points were separated into different multivariate models. 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, whereas lactate level on admission (OR, 1.049; 95% CI, 0.962 to 1.143) was not associated with neurologic outcome (Table 3). Furthermore, lactate clearance was not associated with neurologic outcome at any time point (Fig. 4). Multivariate analysis revealed that a non-shockable rhythm and the SOFA score were associated with in-hospital mortality (Table 4). A higher lactate level at 48 hours (OR, 1.459; 95% CI, 1.181 to 1.803) after admission was associated with an increased in-hospital mortality, whereas the lactate level on admission (OR, 1.063; 95% CI, 0.981 to 1.152) and the lactate levels at 12 hours (OR, 1.031; 95% CI, 0.928 to 1.146) and 24 hours (OR, 1.024; 95% CI, 0.940 to 1.116) after admission were not associated with in-hospital mortality (Table 4). Additionally, lactate clearance was not associated with in-hospital mortality at any time point (Fig. 4).

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.


Related in: MedlinePlus