Department of Cardiology, University Hospital Copenhagen, Rigshospitalet, Denmark.
Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.
Shock. 2020 Jan;53(1):43-49. doi: 10.1097/SHK.0000000000001353.
Cardiogenic shock complicating acute myocardial infarction has a very high mortality. Our present study focuses on serial measurement of lactate during admission due to cardiogenic shock and the prognostic effect of lactate and a relative change in lactate in patients after admission and the institution of intensive care treatment.
This is a secondary analysis of the CardShock study. Data on lactate at baseline were available on 217 of 219 patients.In the study population, the median baseline lactate was 2.8 mmol/L (min-max range, 0.5-23.1 mmol/L).At admission, lactate was predictive of 30-day mortality with an adjusted Hazard ratio (HR) of 1.20 mmol/L (95% confidence interval, CI 1.14-1.27). Within the first 24 h of admission, baseline lactate remained predictive of 30-day mortality. Lactate at 6 h had a HR of 1.14 (95% CI 1.06-1.24) and corresponding values at 12 and 24 h had a HR of 1.10 (1.04-1.17), and of HR 1.19 (95% CI 1.07-1.32), respectively. A 50% reduction in lactate within 6 h resulted in a HR of 0.82 (95% CI 0.72-0.94). Corresponding hazard ratios at 12 and 24 h, were 0.87 (95% CI 0.76-0.98) and 0.74 (95% CI 0.60-0.91), respectively.
The main findings of the present study are that baseline lactate is a powerful predictor of 30-day mortality, lactate at 6, 12, and 24 h after admission are predictors of 30-day mortality, and a relative change in lactate is a significant predictor of survival within the first 24 h after instituting intensive care treatment adding information beyond the information from baseline values.
急性心肌梗死后合并心源性休克的死亡率非常高。我们目前的研究重点是在心源性休克患者入院期间连续测量乳酸，并研究入院后患者的乳酸水平及其相对变化和强化治疗对预后的影响。
这是 CardShock 研究的二次分析。在 219 例患者中，有 217 例患者可获得基线乳酸数据。在研究人群中，中位数基线乳酸值为 2.8mmol/L（最小值-最大值范围，0.5-23.1mmol/L）。入院时，乳酸可预测 30 天死亡率，校正后的危险比（HR）为 1.20mmol/L（95%置信区间，CI 1.14-1.27）。入院后 24 小时内，基线乳酸仍可预测 30 天死亡率。入院后 6 小时的乳酸 HR 为 1.14（95%CI 1.06-1.24），12 小时和 24 小时的相应 HR 为 1.10（1.04-1.17）和 HR 1.19（95%CI 1.07-1.32）。入院后 6 小时内乳酸降低 50%，HR 为 0.82（95%CI 0.72-0.94）。入院后 12 小时和 24 小时的相应 HR 为 0.87（95%CI 0.76-0.98）和 0.74（95%CI 0.60-0.91）。
本研究的主要发现是，基线乳酸是 30 天死亡率的有力预测因子，入院后 6、12 和 24 小时的乳酸是 30 天死亡率的预测因子，而强化治疗后 24 小时内乳酸的相对变化是生存的重要预测因子，除了基线值的信息外，还提供了更多信息。
