Department of Cardiology-University Hospital Bonn, Bonn, Germany.
Hausarztzentrum Rheinbach, Rheinbach, Germany.
PLoS One. 2024 Jul 25;19(7):e0306107. doi: 10.1371/journal.pone.0306107. eCollection 2024.
Lactate and glucose are widely used biochemical parameters in current predictive risk scores for cardiogenic shock. Data regarding the relationship between lactate and glucose levels in cardiogenic shock are limited. Thus, we aimed to analyze glucose and lactate as early markers for in-hospital mortality in cardiogenic shock. In this retrospective cohort study, 312 patients presenting with cardiogenic shock to a tertiary-care hospital between 2016 and 2018 were included. Apparent cardiogenic shock was defined as hypoperfusion with hemodynamic compromise and biochemical marker increase due to diminished tissue perfusion, corresponding to SCAI shock stages. In-hospital mortality was assessed as the primary endpoint. The median age of the study population was 71 (60-79) years and the etiology of cardiogenic shock was acute myocardial infarction in 45.8%. Overall in-hospital mortality was 67.6%. In the receiver operating curve analysis, the area under the receiver-operating curve (AUC) for prediction of in-hospital mortality was higher for lactate (AUC: 0.757) than for glucose (AUC: 0.652). Both values were significantly associated with outcome (groups created with best cutoff values obtained from the Youden index). Correlation analysis showed a significant non-linear association of both values. In a multivariable stepwise Cox regression analysis, lactate remained an independent predictor for in-hospital mortality, whilst glucose, despite being implicated in energy metabolism, was not independently predictive for mortality. Together, these data suggest that lactate at admission is superior for mortality prediction in patients with apparent cardiogenic shock. Glucose was not independently predictive for mortality.
乳酸和葡萄糖是目前用于预测心源性休克风险的生化参数。关于心源性休克患者乳酸和葡萄糖水平之间关系的数据有限。因此，我们旨在分析葡萄糖和乳酸作为心源性休克患者院内死亡率的早期标志物。在这项回顾性队列研究中，纳入了 2016 年至 2018 年间在一家三级医院就诊的 312 例心源性休克患者。明显的心源性休克定义为由于组织灌注减少导致的血流动力学受损和生化标志物增加的低灌注，对应于 SCAI 休克阶段。院内死亡率被评估为主要终点。研究人群的中位年龄为 71（60-79）岁，心源性休克的病因是急性心肌梗死占 45.8%。总的院内死亡率为 67.6%。在接受者操作曲线分析中，乳酸预测院内死亡率的曲线下面积（AUC）高于葡萄糖（AUC：0.757 对 0.652）。这两个值都与结果显著相关（通过获得最佳截断值的约登指数创建的组）。相关性分析显示这两个值之间存在显著的非线性关联。在多变量逐步 Cox 回归分析中，乳酸仍然是院内死亡率的独立预测因子，而葡萄糖虽然与能量代谢有关，但对死亡率没有独立预测能力。综上所述，这些数据表明，入院时的乳酸对明显的心源性休克患者的死亡率预测更有优势。葡萄糖对死亡率没有独立的预测作用。
