Normalized Lactate Load Independently Linked to In-Hospital Mortality in Cardiogenic Shock Patients: Study

"Increased normalized lactate load was associated with an increased risk of in-hospital death, even after adjusting for potential confounders," the researchers wrote. They noted that normalized lactate load demonstrated a better predictive ability for in-hospital mortality than the initial lactate value, maximum lactate value, and mean lactate value and was comparable to the SOFA score.

Early prognosis evaluation is crucial for decision-making in cardiogenic shock (CS) patients. Dynamic lactate assessment, for example, normalized lactate load, has been a better prognosis predictor than single lactate value in septic shock. Our objective was to investigate the correlation between normalized lactate load and in-hospital mortality in patients with CS.

Cardiogenic shock is characterized by inadequate blood flow to the organs, leading to tissue hypoperfusion and increased lactate production. Early prognosis evaluation is essential for decision-making in CS patients. Dynamic lactate assessment, such as normalized lactate load, has proven to be a more effective predictor of outcomes than single lactate measurements in cases of septic shock.

Against the above background, Lin Yuan, Capital Medical University, Beijing, China, and colleagues aimed to investigate the correlation between normalized lactate load and in-hospital mortality in patients with CS.

For this purpose, they obtained data from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Lactate load was calculated as the cumulative area under the lactate curve, and normalized lactate load was computed as the division of lactate load by the corresponding period.

The research team constructed Receiver Operating Characteristic (ROC) curves, and the DeLong test was used to evaluate areas under the curves (AUC) for various parameters.

The study led to the following findings:

· The study involved a cohort of 1932 CS patients, with 687 individuals (36.1%) experiencing mortality during their hospitalization.

· The AUC for normalized lactate load demonstrated significant superiority compared to the first lactate (0.675 vs. 0.646), maximum lactate (0.675 versus 0.651), and mean lactate (0.675 versus 0.669).

· The AUC for normalized lactate load showed comparability to that of the Sequential Organ Failure Assessment (SOFA) score (0.675 versus 0.695).

The findings showed that the normalized lactate load has been recognized as an independent predictor of in-hospital mortality in patients with cardiogenic shock, exhibiting a predictive capacity comparable to the SOFA score.

"This highlights the potential of normalized lactate load as a valuable prognostic marker and its role in informing treatment decisions for individuals with cardiogenic shock," the researchers concluded.

Reference:

Wu, X., Yuan, L., Xu, J. et al. Normalized lactate load as an independent prognostic indicator in patients with cardiogenic shock. BMC Cardiovasc Disord 24, 348 (2024). https://doi.org/10.1186/s12872-024-04013-8