Arterial Lactate in Cardiogenic Shock: Prognostic Value of Clearance Versus Single Values

Georg Fuernau*, Steffen Desch, Suzanne de Waha-Thiele, Ingo Eitel, Franz Josef Neumann, Marcus Hennersdorf, Stephan B. Felix, Andreas Fach, Michael Böhm, Janine Pöss, Christian Jung, Taoufik Ouarrak, Steffen Schneider, Karl Werdan, Uwe Zeymer, Holger Thiele

*Corresponding author for this work
2 Citations (Scopus)


Objectives: This study sought to compare single lactate values at admission (L1) and after 8 h (L2) with lactate clearance (LC) for mortality prediction in cardiogenic shock (CS). Background: Early estimation of prognosis in CS complicating acute myocardial infarction is crucial for tailored treatment selection. Arterial lactate is the most widely used point-of-care parameter in CS. In septic shock, lactate reduction over time—LC—has been extensively investigated. However, in CS, only limited data exist, and the prognostic value of LC is unknown. Methods: This study is a subanalysis of the IABP-SHOCK II (Intraaortic Balloon Pump in Cardiogenic Shock II) trial and the corresponding registry. Lactate levels were prospectively collected. All-cause mortality at 30 days was assessed as primary endpoint. Results: For 671 of 783 (85.7%) patients, L1 and L2 values were available. The area under the receiver-operating characteristic curve (L1: 0.69; L2: 0.76; LC: 0.59) showed no difference between L1 and LC (p = 0.20). In contrast, L2 was a significantly better predictive parameter than L1 or LC (p < 0.001 for both). In multivariable stepwise Cox regression analysis, L2 ≥3.1 mmol/l (best cutoff value by Youden index) and LC <–3.45%/h remained independently predictive for time to death (p < 0.001 for both), with L2 showing the highest chi-square test score (42.1) and hazard ratio (2.89; 95% confidence interval: 2.10 to 3.97). Conclusions: Arterial lactate after 8 h is superior in mortality prediction in comparison with baseline lactate and LC. A cutoff value of 3.1 mmol/l for lactate after 8 h showed the best discrimination for assessing early prognosis in CS and may serve as new treatment goal. (Intraaortic Balloon Pump in Cardiogenic Shock II [IABP-SHOCK II]; NCT00491036)

Original languageEnglish
JournalJACC: Cardiovascular Interventions
Issue number19
Pages (from-to)2208-2216
Number of pages9
Publication statusPublished - 12.10.2020

Research Areas and Centers

  • Centers: Cardiological Center Luebeck (UHZL)

DFG Research Classification Scheme

  • 205-12 Cardiology, Angiology


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