OR10-2 | Identifying a Critical Threshold of Lactate Elevation in Cardiogenic Shock Using a Novel Measurement: The Lactate Time Integral

Early risk-stratification and timing of intervention are crucial in treatment of cardiogenic shock (CS), which carries a persistently high mortality rate. Degree of lactate elevation has been shown to have prognostic implications on mortality, but a critical threshold for lactate elevation or clearance has not been identified. Additionally, the applicability of these findings to patients with severe CS (i.e. SCAI D/E) remain uncertain. We performed a retrospective, single-center study of 231 patients (January 2017 to March 2023) with new-onset severe CS, requiring large-bore (>10 Fr) temporary mechanical circulatory device (89% SCAI D/E). We compared measures of lactate clearance with all-cause in-hospital mortality, including complete lactate clearance (CLC) time, peak lactate, and lactate time integral (LTI, Figure 1). We also calculated an optimal discriminatory point with regards to LTI. Overall in-hospital mortality was 50.2% (116 patients). Survivors were younger and less likely to be on renal replacement therapy, ventilated, or have suffered cardiac arrest at presentation of CS. On multivariate analysis, increased lactate time-integral (p = 0.018) and peak lactate (p = 0.005) over the first 72 hours and CLC at 24 (p = 0.037, OR 1.9), 48 (p = 0.031, OR 2.4), and 72 hours (p = 0.047, OR 2.7) were all independently associated with mortality. In a Youden analysis, the optimal discriminatory point for in-hospital survival was 41 mmol/L-hrs (OR 2.5). In severe CS requiring temporary mechanical circulatory support, LTI and CLC can identify patients with a worse prognosis.