Association between early lactate-related variables and 6-month neurological outcome in out-of-hospital cardiac arrest patients
Copyright © 2024 Elsevier Inc. All rights reserved..
INTRODUCTION: The role of lactate measurement in out-of-hospital cardiac arrest (OHCA) survivors remains controversial. We assessed the association between early lactate-related variables, OHCA characteristics, and long-term neurological outcome.
METHODS: In OHCA patients who received targeted temperature management, lactate levels were measured at 0, 12, and 24 h after the return of spontaneous circulation. We calculated lactate clearance and time-weighted cumulative lactate (TWCL), which represent the area under the time-lactate curve. The area under the receiver operating characteristic curve (AUC) and the adjusted odds ratios (AORs) of lactate-related variables for predicting 6-month poor outcome (Cerebral Performance Category 3-5) were evaluated. Interactions between lactate variables and characteristics of OHCA were evaluated by a multivariable logistic model with interaction terms and subgroup analysis.
RESULTS: A total of 347 OHCA patients were included. After adjustment, higher lactate levels at the three time points were associated with a poor outcome (AOR 1.10 [95% CI, 1.03-1.18], AOR 1.15 [95% CI, 1.02-1.29], and AOR 1.36 [95% CI, 1.15-1.60], respectively), while TWCL was the only lactate kinetics variable associated with a poor outcome (AOR 1.29 [95% CI, 1.12-1.49]). We identified several interactions between lactate-related variables and OHCA characteristics. In particular, the AUC of TWCL was excellent in cases of noncardiac etiology (AUC 0.92 [95% CI, 0.86-0.96] but only moderate in cardiac etiology (AUC 0.69 [95% CI, 0.62-0.75]).
CONCLUSIONS: Early lactate levels, especially at 24 h, and TWCL were independent predictors of neurologic outcome in these patients, whereas lactate clearance was not. The prognostic ability of lactate-related variables varied depending on the OHCA characteristics.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:78 |
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| Enthalten in: |
The American journal of emergency medicine - 78(2024) vom: 31. März, Seite 62-68 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Choi, Se Young [VerfasserIn] |
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| Links: |
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| Themen: |
33X04XA5AT |
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| Anmerkungen: |
Date Completed 25.03.2024 Date Revised 25.03.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.ajem.2024.01.005 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM367084503 |
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| 100 | 1 | |a Choi, Se Young |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Association between early lactate-related variables and 6-month neurological outcome in out-of-hospital cardiac arrest patients |
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| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2024 Elsevier Inc. All rights reserved. | ||
| 520 | |a INTRODUCTION: The role of lactate measurement in out-of-hospital cardiac arrest (OHCA) survivors remains controversial. We assessed the association between early lactate-related variables, OHCA characteristics, and long-term neurological outcome | ||
| 520 | |a METHODS: In OHCA patients who received targeted temperature management, lactate levels were measured at 0, 12, and 24 h after the return of spontaneous circulation. We calculated lactate clearance and time-weighted cumulative lactate (TWCL), which represent the area under the time-lactate curve. The area under the receiver operating characteristic curve (AUC) and the adjusted odds ratios (AORs) of lactate-related variables for predicting 6-month poor outcome (Cerebral Performance Category 3-5) were evaluated. Interactions between lactate variables and characteristics of OHCA were evaluated by a multivariable logistic model with interaction terms and subgroup analysis | ||
| 520 | |a RESULTS: A total of 347 OHCA patients were included. After adjustment, higher lactate levels at the three time points were associated with a poor outcome (AOR 1.10 [95% CI, 1.03-1.18], AOR 1.15 [95% CI, 1.02-1.29], and AOR 1.36 [95% CI, 1.15-1.60], respectively), while TWCL was the only lactate kinetics variable associated with a poor outcome (AOR 1.29 [95% CI, 1.12-1.49]). We identified several interactions between lactate-related variables and OHCA characteristics. In particular, the AUC of TWCL was excellent in cases of noncardiac etiology (AUC 0.92 [95% CI, 0.86-0.96] but only moderate in cardiac etiology (AUC 0.69 [95% CI, 0.62-0.75]) | ||
| 520 | |a CONCLUSIONS: Early lactate levels, especially at 24 h, and TWCL were independent predictors of neurologic outcome in these patients, whereas lactate clearance was not. The prognostic ability of lactate-related variables varied depending on the OHCA characteristics | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Lactate | |
| 650 | 4 | |a Neurological outcomes | |
| 650 | 4 | |a Out-of-hospital cardiac arrest | |
| 650 | 4 | |a Prognosis | |
| 650 | 4 | |a Targeted temperature management | |
| 650 | 7 | |a Lactic Acid |2 NLM | |
| 650 | 7 | |a 33X04XA5AT |2 NLM | |
| 700 | 1 | |a Oh, Sang Hoon |e verfasserin |4 aut | |
| 700 | 1 | |a Park, Kyu Nam |e verfasserin |4 aut | |
| 700 | 1 | |a Youn, Chun Song |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Han Joon |e verfasserin |4 aut | |
| 700 | 1 | |a Park, Sang Hyun |e verfasserin |4 aut | |
| 700 | 1 | |a Lim, Jee Yong |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Hyo Joon |e verfasserin |4 aut | |
| 700 | 1 | |a Bang, Hyo Jin |e verfasserin |4 aut | |
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