Serial daily lactate levels association with 30-day outcome in cardiogenic shock patients treated with VA-ECMO: a post-hoc analysis of the HYPO-ECMO study

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dc.catalogadorpau
dc.contributor.authorLevy, Bruno
dc.contributor.authorGirerd, Nicolas
dc.contributor.authorBaudry, Guillaume
dc.contributor.authorDuarte, Kevin
dc.contributor.authorCuau, Samuel
dc.contributor.authorBakker, Jan
dc.contributor.authorKimmoun, Antoine
dc.contributor.otherHYPO-ECMO
dc.contributor.otherECMO Network
dc.date.accessioned2024-04-03T16:53:08Z
dc.date.available2024-04-03T16:53:08Z
dc.date.issued2024
dc.date.updated2024-03-31T01:04:37Z
dc.description.abstractReliable predictors of outcomes in venoarterial extracorporeal membrane oxygenation (VA-ECMO) therapy are limited. While elevated lactate levels over time have been linked to outcomes in cardiogenic shock (CS), their significance in VA-ECMO-treated patients remains inconclusive. Methods We conducted a post hoc analysis of data from the HYPO-ECMO trial, which compared normothermia to moderate hypothermia in CS patients supported by VA-ECMO. We examined daily lactate levels collected over a week to assess their correlation with 30-day mortality. Results Among the 318 out of 334 patients (95%) with baseline lactate measurements, 66 had normal levels (< 2.2 mmol/l, 21%). No difference was found in lactate course between moderate hypothermia and normothermia groups. Lactate levels were consistently higher in non-survivors at each time point (p = 0.0002). Baseline hyperlactatemia was associated with an increased risk of death (Hazard Ratio [HR]: 1.85 (1.12–3.05), p = 0.016). When considering all time points, lactate levels during the ICU stay were significantly and gradually associated with a higher risk of death (p < 0.0001). In the overall population, a decrease in lactate levels was not linked to 30-day mortality. However, patients with baseline hyperlactatemia exhibited a more significant decrease in lactate levels from day one to seven (p < 0.0001). In this group, survivors had a significantly greater decrease in lactate levels at day 1 compared to non-survivors (63% (48–77) versus 57% (21–75), p = 0.026). Patients experiencing a secondary increase in lactate (24%) had a worse prognosis (Hazard Ratio: 1.78 (1.21–2.61), p = 0.004), regardless of both baseline lactate levels and the occurrence of severe ischemic adverse events (intestinal and/or limb ischemia). Conclusions The consistent and significant association between lactate levels, whether assessed at baseline or during ICU treatment, and the risk of mortality underscores the pivotal prognostic relevance of lactate levels in patients with CS undergoing VA-ECMO therapy. The study findings provide some novel insights, regarding the trend profile and the relevance of a second peak during the 7 day period after ECMO start. Trial Registration identifier NCT02754193 registered on 2016–04–12.
dc.fechaingreso.objetodigital2024-04-03
dc.format.extent12 páginas
dc.fuente.origenBiomed Central
dc.identifier.citationAnnals of Intensive Care. 2024 Mar 27;14(1):43
dc.identifier.urihttps://doi.org/10.1186/s13613-024-01266-6
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/84921
dc.information.autorucEscuela de Medicina; Bakker, Jan; 0000-0003-2236-7391; 1044227
dc.issue.numero43
dc.language.isoen
dc.nota.accesocontenido completo
dc.revistaAnnals of Intensive Care
dc.rightsacceso abierto
dc.rights.holderThe Author(s)
dc.subject.ods03 Good health and well-being
dc.subject.odspa03 Salud y bienestar
dc.titleSerial daily lactate levels association with 30-day outcome in cardiogenic shock patients treated with VA-ECMO: a post-hoc analysis of the HYPO-ECMO study
dc.typeartículo
dc.volumen14
sipa.codpersvinculados1044227
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