Key result
Lactate level on admission predicted neurological outcomes after cardiac arrest with a pooled AUC of 0.77 (95% CI 0.73-0.80), serving as a more robust surrogate marker than lactate clearance.
Why the study?
Does blood lactate or lactate clearance predict neurological outcomes in patients after cardiac arrest?
Meta-Analysis
Does blood lactate or lactate clearance predict neurological outcomes in patients after cardiac arrest?
Effect estimate: AUC 0.77 (95% CI 0.73-0.80)
p-value: p=<0.001
Lactate levels on admission and up to 48 hours are more robust predictors of neurological outcomes after cardiac arrest compared to lactate clearance.
Lactate levels may aid post-arrest prognostication; supports lactate over clearance as a more stable marker but leaves thresholds for clinical use open.
AIMS: Lactate and lactate clearance were supposed to be associated with cardiac arrest outcomes, but studies obtained different results. Thus, we conducted this meta-analysis to investigate the association between lactate or lactate clearance and neurological outcomes and their usefulness for prediction of neurological outcomes. METHODS: We conducted a systematic search in PubMed, Web of science, EMBASE, Medline, and Google Scholar until May 1, 2018, for relevant studies. Studies reporting lactate, lactate clearance on admission, or other time points after admission associated with neurological outcomes were included in our analysis. Pooled effect date was shown as weighed mean difference (WMD) and 95% confidence interval (CI). To measure the usefulness of lactate on admission to predict neurological outcomes, we also pooled the data of diagnostic test. RESULTS: <0.001). Furthermore, the pooled AUC for lactate level on admission to predict neurological outcomes was 0.77 (95%CI: 0.73-0.80). However, a significant association between lactate clearance and neurological outcomes was only found in 24h but not 12h lactate clearance rate. CONCLUSIONS: Lactate levels on admission and all time points up to 48h were associated with neurological outcomes after CA, whereas the association between lactate clearance and neurological outcomes was not so stable. Lactate was a more robust surrogate marker than lactate clearance to predict neurological outcomes after CA.
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Zhou et al. (2018) conducted a meta-analysis in cardiac arrest. Lactate and lactate clearance was evaluated on neurological outcomes (AUC 0.77, 95% CI 0.73-0.80, p=<0.001). Lactate level on admission predicted neurological outcomes after cardiac arrest with a pooled AUC of 0.77 (95% CI 0.73-0.80), serving as a more robust surrogate marker than lactate clearance.
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