The predictive value of early arterial lactate clearance rate in cardiogenic shock

doi:10.3877/cma.j/jssn.2096-1537.2017.01.011

Abstract

Abstract:

Objective

To explore the predictive value of early arterial lactate and lactate clearance rate in cardiogenic shock.

Methods

The study prospectively recruited 94 cardiogenic shock patients who admitted to the department of critical care medicine in Subei People′ Hospital from February 2013 to March 2016. The arterial lactate at the moment of diagnosis of (0 h lactate) and 6 h after diagnosis were reviewed. According to the outcome, patients were divided into survival group (n=55) and non-survival group (n=30). The arterial lactate at 0 h and 6 h and lactate clearance rate in each group were analyzed. The receiver-operating characteristic (ROC) curve was plotted to assess the predictive value of lactate and lactate clearance rate.

Results

(1)Arterial lactate at 0 h in survival group (3.35±1.03)mmol/L was significantly lower than in non-survival group (4.18±1.39)mmol/L, the difference was statistically significant (t=2.056, P<0.05). Compared with non-survival group (3.43±1.54)mmol/L, arterial lactate at 6 h in survival group were significantly lower (1.98±0.69)mmol/L, the difference was statistically significant (t=4.464, P<0.05). (2)The cut-off value of arterial lactate at 0 h and 6 h was 3.39 mmol/L and 2.32 mmol/L, with sensitivity and specificity both being 80% and 72%, respectively. Furthermore, the cut-off value of arterial lactate clearance rate was 30.07%, with sensitivity and the specificity being 68% and 67%, respectively.

Conclusion

Early arterial lactate clearance rate could be an indicator to predict the prognosis in cardiogenic shock patients.

Key words: Shock, cardiogenic, Prognosis, Lactate clearance rate

Hualing Wang, Ruiqiang Zheng, Qihong Chen. The predictive value of early arterial lactate clearance rate in cardiogenic shock[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2017, 03(01): 50-54.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j/jssn.2096-1537.2017.01.011

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Figures/Tables 5

References 15

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	存活组（55例）	死亡组（30例）	统计值	P值
性别			χ²⁼0.061	0.840
男性	33	17
女性	22	13
年龄（岁）	54.8±11.2	55.3±11.3	t=1.191	0.234
APACHEⅡ评分（分数，±s）	15.4±2.1	21.5±3.4	t=8.243	0.002
入院NYHA分级（例数）			χ²⁼0.454	0.797
Ⅱ级	5	1
Ⅲ级	11	8
Ⅵ级	39	21
基础心脏病（例数）			χ²⁼1.264	0.867
冠状动脉粥样硬化性心脏病	27	23
风湿性心脏病	12	5
扩张型心肌病	2	1
病毒性心肌炎	3	1
其他	1	0
肝功能（例数）			χ²⁼0.927	0.372
正常	28	12
异常	27	18
血肌酐（μmol/L，±s)	85.6±12.8	92.8±14.5	t=1.562	0.189
是否手术（例数）
介入手术	10	6	χ²⁼0.042	1.000
外科手术	6	4	χ²⁼0.110	0.737
IABP	4	3	χ²⁼0.002	1.000
ECMO	0	0

	存活组（55例）	死亡组（30例）	统计值	P值
性别			χ²⁼0.061	0.840
男性	33	17
女性	22	13
年龄（岁）	54.8±11.2	55.3±11.3	t=1.191	0.234
APACHEⅡ评分（分数，±s）	15.4±2.1	21.5±3.4	t=8.243	0.002
入院NYHA分级（例数）			χ²⁼0.454	0.797
Ⅱ级	5	1
Ⅲ级	11	8
Ⅵ级	39	21
基础心脏病（例数）			χ²⁼1.264	0.867
冠状动脉粥样硬化性心脏病	27	23
风湿性心脏病	12	5
扩张型心肌病	2	1
病毒性心肌炎	3	1
其他	1	0
肝功能（例数）			χ²⁼0.927	0.372
正常	28	12
异常	27	18
血肌酐（μmol/L，±s)	85.6±12.8	92.8±14.5	t=1.562	0.189
是否手术（例数）
介入手术	10	6	χ²⁼0.042	1.000
外科手术	6	4	χ²⁼0.110	0.737
IABP	4	3	χ²⁼0.002	1.000
ECMO	0	0

组别	例数	0 h动脉血乳酸（mmol/L）	6 h动脉血乳酸（mmol/L）	6 h乳酸清除率（%）
存活组	55	3.35±1.03	1.98±0.69	38.7±17.9
死亡组	30	4.18±1.39	3.43±1.54	18.8±14.7
t值		2.056	4.464	21.842
P值		0.041	0.000	0.000

组别	例数	0 h动脉血乳酸（mmol/L）	6 h动脉血乳酸（mmol/L）	6 h乳酸清除率（%）
存活组	55	3.35±1.03	1.98±0.69	38.7±17.9
死亡组	30	4.18±1.39	3.43±1.54	18.8±14.7
t值		2.056	4.464	21.842
P值		0.041	0.000	0.000

	曲线下面积	阈值	敏感度（%）	特异度（%）	显著性	95%可信区间
0 h动脉血乳酸（mmol/L）	0.727	3.39 （mmol/L）	80	72	0.018	0.566~0.888
6 h动脉血乳酸（mmol/L）	0.856	2.32 （mmol/L）	80	72	0.000	0.742~0.970
6 h乳酸清除率（%）	0.808	30.07 （%）	68	67	0.001	0.058~0.362

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