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Early Lactate Values After Out-of-Hospital Cardiac Arrest

Associations With One-Year Outcome

Laurikkala, Johanna*; Skrifvars, Markus B.*; Bäcklund, Minna*; Tiainen, Marjaana; Bendel, Stepani; Karhu, Jaana§; Varpula, Tero*; Vaahersalo, Jukka*; Pettilä, Ville*; Wilkman, Erika* the FINNRESUSCI study group

doi: 10.1097/SHK.0000000000001145
Clinical Science Aspects

Background: Previous studies have shown associations between high admission serum lactate, lower lactate clearance, and increased short-term mortality after out-hospital cardiac arrest (OHCA). We studied whether lactate levels predict long- term outcome after OHCA.

Methods: We included 458 OHCA patients with lactate measurements during intensive care unit (ICU) stay from the prospective FINNRESUSCI study. We evaluated thresholds for time-weighted (TW) mean lactate values for the first 24, 48, and 72 h. We analyzed lactate clearance and used multivariate regression to assess the prognostic value of the different measurement time points.

Results: The admission lactate (median [IQR] 3.06 [2.68–3.44] mmol/L vs 4.76 [4.29–5.23] mmol/L) and the last measured lactate (0.98 [0.90–1.06] mmol/L vs 2.40 [2.03–2.78] mmol/L) were higher in non-survivors than in survivors, as were the lowest (0.73 [0.67–0.79] mmol/L vs 1.83 [1.52–2.14] mmol/L) and the highest (3.44 [3.05–3.83] mmol/L vs 5.25 [4.76–5.74] mmol/L) lactate values (all P < 0.001). Time-weighted mean lactate values for the first 24, 48, 72, and for the entire ICU stay were lower in patients with good outcome (P < 0.001). In multivariate backward regression models, time-weighted mean lactate for the entire ICU stay (OR 1.41 per mmol/L, CI 95% 1.08–1.86, P = 0.013) and the last measured lactate in the ICU (OR 2.16 per mmol/L, CI 95% 1.47–3.18, P < 0.001) were independent predictors of poor 1-year outcome.

Conclusions: In the present study time-weighted mean lactate values for the entire ICU stay, and the last measured lactate value in the ICU, but not admission lactate or lactate clearance were independent predictors of poor 1-year outcome.

*Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland

Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland

Department of Anesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland

§Department of Anesthesiology, Division of Intensive Care Medicine, Oulu University Hospital, Oulu, Finland

Address reprint requests to Erika Wilkman, MD, PhD, Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, PB 340, 00029 HUS, Helsinki University Hospital, Helsinki, Finland; E-mail: erika.wilkman@hus.fi

Received 9 February, 2018

Revised 27 February, 2018

Accepted 23 March, 2018

This study has received unrestricted funding from the Hospital District of Helsinki and Uusimaa (TYH2014221), Valtion tutkimusraha (VTR-Y102011091), Finska Läkaresällskapet, Medicinska Understödsföreningen Liv och Hälsa and Stiftelsen Dorothea Olivia, Karl Walter och Jarl Walter Perkléns minne.

The authors report no conflicts of interest.

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© 2019 by the Shock Society