Serial daily lactate levels association with 30-day outcome in cardiogenic shock patients treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO): a post-hoc analysis of the HYPO-ECMO study
Primary result · 30-day mortality by baseline hyperlactatemiaResult — go to the resultHazard ratio 1.85 CI 1.12–3.05Authors' conclusion
The consistent and significant association between lactate levels, whether assessed at baseline or during ICU treatment, and the risk of mortality underscores the pivotal prognostic relevance of lactate levels in patients with CS undergoing VA-ECMO therapy.
Study context
- Population
- Cardiogenic shock (CS) patients supported by VA-ECMO in the HYPO-ECMO trial (normothermia vs moderate hypothermia)of 334 with baseline lactate
- Participants
- 318 patients
- Comparison
- Lactate levels vs 30-day mortality
- Normal lactaten = 66reference
- Primary endpoint
- Association of daily lactate levels with 30-day mortality
- Follow-up
- 30 days
Methodological detailspost hoc analysis
- Post hoc analysis
Primary result
30-day mortality by baseline hyperlactatemia
Hazard ratio
1.85
CI 1.12–3.05
P = 0.016
Hyperlactatemia vs Normal lactate
HR 1.85 (CI 1.12–3.05); P = 0.016
As reported in the abstract
- Lactate levels consistently higher in non-survivors at each time point
- P = 0.0002
- Lactate levels during ICU stay significantly and gradually associated with higher risk of death
- P < 0.0001
Further findings
| Outcome | HR (CI) | P value | |
|---|---|---|---|
| Secondary increase in lactate (24% of patients) and prognosisSecondary lactate increase vs No secondary increase | 1.78 (1.21–2.61) | P = 0.004 | |
| 0.20.5125Hazard ratio (log scale) |
| Outcome | Survivors | Non-survivors | P value |
|---|---|---|---|
| Lactate decrease at day 1, baseline hyperlactatemia (subgroup): survivors vs non-survivors | 63% (unspecified 48–77) | 57% (unspecified 21–75) | P = 0.026 |
- Secondary increase in lactate (24% of patients) and prognosis: regardless of baseline lactate and severe ischemic adverse events
Lactate course by temperature arm
- No difference in lactate course between moderate hypothermia and normothermia
Decrease in lactate levels, overall population
- Greater decrease in lactate day 1 to 7 in baseline hyperlactatemia
- P < 0.0001
- Decrease in lactate not linked to 30-day mortality
Original publication
Serial daily lactate levels association with 30-day outcome in cardiogenic shock patients treated with VA-ECMO: a post-hoc analysis of the HYPO-ECMO study. Ann Intensive Care. Published 27 March 2024. doi:10.
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