Relationship between lactate level and clearance during extracorporeal life support and prognosis in elderly cardiac intensive care patients
10.3969/j.issn.1009-0126.2025.11.008
- VernacularTitle:体外生命支持期间乳酸水平和清除率与老年心脏重症监护患者预后的关系
- Author:
Kewen CHEN
1
;
Xinhua MA
;
Kang HUANG
;
Huan HUANG
;
Songbai WU
;
Yao DAI
Author Information
1. 中南大学湘雅医学院附属长沙医院重症医学科,长沙 410005
- Publication Type:Journal Article
- Keywords:
extracorporeal membrane oxygenation;
lactic acid;
intensive care units;
prognosis
- From:
Chinese Journal of Geriatric Heart Brain and Vessel Diseases
2025;27(11):1479-1483
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the presumed correlation between lactate level and clearance during extracorporeal life support(ECLS)and death in elderly cardiac intensive care patients.Methods A total of 93 elderly cardiac intensive care patients who received ECLS in Department of Critical Care Medicine,Xiangya Medical College Affiliated Changsha Hospital,Central South University,from March 2019 to October 2024 were retrospectively included to manage low cardiac production syndrome after major cardiac surgery.According to hospital outcomes,the patients were divided into a death group(n=45)and a survival group(n=48).Blood lactate measurements were performed every 4 hours from the beginning of ECLS treatment to calculate peak lactate and lactate clearance rate(LCR).Routine ICU scores,such as sequential organ failure score(SOFA)and reactive organ dysfunction(ROD)score,and postoperative complications were recorded.Results The death group received larger amounts of packed red blood cell concentrate,fresh frozen plasma and platelet concentrate,and exhibited higher ratios of norepinephrine and epinephrine administration and higher incidences of re-thoracotomy and hemolytic episodes when compared with the survival group(P＜0.05,P＜0.01).At the end of ECLS,higher SOFA and ROD scores were observed in the death group(P＜0.01).The death group also demonstrated higher lactate level from venoarterial ECLS(P＜0.001)and increased median peak lactate level,but lower median LCR than the survival group(P＜0.01).Multivariate logistic analysis showed that peak lactate and LCR were independent prognostic factors in the elderly cardiac ICU patients(P＜0.05,P＜0.01).The AUC value(95％CI)of peak lactate and LCR in predicting patient outcomes was 0.723(95％CI:0.615-0.831)and 0.846(95％CI:0.761-0.932),respectively,and the value of their combination in predicting in-hospital death was 0.846(95％CI:0.762-0.931),with a sensitivity of 0.629 and a specificity of 0.937.Conclusion Lactate level and its clearance rate during ECLS can affect the survival rate of elderly cardiac intensive care patients.Peak lactate and LCR can predict the prognosis of elderly cardiac intensive care patients,and can be used as prognostic indicators for clinical monitoring.
