Prognostic value of arterial blood lactate for patients with cardiogenic shock receiving extracorporeal membrane oxygenation
10.3760/cma.j.issn.1001-4497.2019.10.009
- VernacularTitle: 血乳酸测定评估ECMO治疗的心源性休克患者预后价值
- Author:
Delin LIU
1
;
Yuguang WANG
1
;
Minna WANG
1
;
Yuan LIU
1
;
Li CHENG
1
;
Qifeng ZHANG
1
;
Xiaoxue YIN
1
;
Wei LIU
1
;
Gang YE
1
Author Information
1. Emergency Intensive Care Unit, Beijing Luhe Hospital, Affiliated to Capital Medical University, Beijing 101121, China
- Publication Type:Clinical Trail
- Keywords:
Lactate;
Extracorporeal membrane oxygenation;
Cardiogenic shock;
Prognosis
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2019;35(10):617-622
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the prognostic value of arterial blood lactate for patients with cardiogenic shock receiving extracorporeal membrane oxygenation(ECMO).
Methods:A retrospective analysis was conducted. Twenty-three patients diagnosed with cardiogenic shock receiving veno-arterial(V-A) ECMO admitted to department of Emergency Intensive Care Unit(EICU) of Beijing Luhe Hospital Affiliated to Capital Medical University from January 2017 to December 2018 were enrolled.
Results:There were 10 cases in the survival group and 13 cases in the death group. Compared with survival group, APACHE-Ⅱ score was higher, CRRT applied higher percentage, PH and oxygenation index was worse in the death group(P<0.05). The lactate of the death group was significantly higher than that of the survival group at initial time at EICU, 1 h before ECMO and 0h before ECMO(P<0.05). During the ECMO operation, lactate levels in the death group at 8 h and 12 h were significantly higher than those in the survival group(P<0.05). There was no statistically significant difference in lactate clearance rate between the two groups before and after ECMO operation in each observation period(P>0.05). On the 2nd day of ECMO operation, CRRT usage time was shorter and daily liquid balance was more negative in the survival group(P<0.05). APACHE-Ⅱscore, initial lactate at EICU, lactate at ECMO 8 h and lactate at ECMO 12 h had predictive value for 30-day death of patients. The area under ROC curve(AUC) of initial lactate at EICU was 0.845, and 95% confidence interval(95%CI)=0.653-1.000. The AUC of ECMO 8 h lactate was 0.836, 95%CI: 0.634-1.000. The AUC of ECMO 12 h lactate was 0.873, 95%CI: 0.697-1.000. The AUC of APACHE-Ⅱscore was 0.891, 95%CI: 0.717-1.000. The sensitivity and specificity of prognosis prediction were 72.7% and 100% when lactate was more than 7.3 mmol/L at the time of admission into EICU as the optimal critical value.
Conclusion:Arterial blood lactate could be used as an important marker for evaluating the prognosis of cardiogenic shock patients on ECMO. The value of lactate clearance rate may be affected by combined CRRT.
