Higher baseline arterial lactate levels were associated with increased 30-day mortality in both ECLS (tertile 3 vs 1 RR 2.03; 95% CI 1.36-3.05) and control groups, without affecting ECLS efficacy.
Cohort (n=412)
Does extracorporeal life support (ECLS) therapy reduce 30-day all-cause mortality compared to medical therapy alone across different baseline lactate levels in patients with infarct-related cardiogenic shock?
Baseline arterial lactate is a strong prognostic marker for 30-day mortality in infarct-related cardiogenic shock, but does not identify a specific subgroup that benefits from ECLS therapy.
Effect estimate: RR 2.03 (95% CI 1.36-3.05)
Abstract Background Baseline arterial lactate level is a well-established marker of shock severity and prognosis in infarct-related cardiogenic shock (AMI-CS). In this substudy of the ECLS-SHOCK trial we investigated the prognostic value of lactate in patients with and without extracorporeal life support (ECLS) therapy and investigated its influence on the effect of ECLS therapy. Methods Of the 420 patients enrolled in the ECLS-SHOCK trial, 412 patients with available arterial lactate values at baseline (n=207 in ECLS group, n=205 in control group) were included and divided into tertiles ( 5.3, 5.3-8.6, 8.6 mmol/L). The primary endpoint was 30-day all-cause mortality. Results Higher baseline lactate levels were associated with higher 30-day mortality in both groups (ECLS group: tertile 3 vs. tertile 1 relative risk (RR) 2.03 95 % confidence interval (CI) 1.36-3.05, tertile 2 vs. tertile 1 RR 1.71 95 % CI 1.13-2.59; control group: tertile 3 vs. tertile 1 RR 2.82 95 % CI 1.79-4.44, tertile 2 vs. 1 RR 2.03 95 %CI 1.24-3.33) (Figure 1). No significant benefit of ECLS therapy in comparison to medical therapy alone could be observed in any of the subgroups (Figure 2). Conclusion Arterial lactate level at baseline was significantly associated with 30-day mortality in patients receiving ECLS therapy and in patients receiving medical therapy alone. However, the efficacy of ELCS treatment was not affected by baseline lactate values.
Buch et al. (Fri,) conducted a cohort in Infarct-related cardiogenic shock (AMI-CS) (n=412). Extracorporeal life support (ECLS) vs. Medical therapy alone was evaluated on 30-day all-cause mortality (RR 2.03, 95% CI 1.36-3.05). Higher baseline arterial lactate levels were associated with increased 30-day mortality in both ECLS (tertile 3 vs 1 RR 2.03; 95% CI 1.36-3.05) and control groups, without affecting ECLS efficacy.