Early lactate clearance is associated with improved outcomes in patients with postcardiac arrest syndrome: A prospective, multicenter observational study (SOS-KANTO 2012 study)

SOS-KANTO 2012 study group

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23 Citations (Scopus)

Abstract

Objectives: To determine whether early lactate reduction is associated with improved survival and good neurologic outcome in patients with out-of-hospital cardiac arrest. Design: Ad hoc data analysis of a prospective, multicenter observational study. Setting: Out-of-hospital cardiac arrest patients at 67 emergency hospitals in Kanto, Japan between January 2012 and March 2013. Patients: Adult patients with out-of-hospital cardiac arrest admitted to the hospital after successful resuscitation were identified. Interventions: Blood lactate concentrations were measured at hospital admission and 6 h after hospital admission. Early lactate clearance was defined as the percent change in lactate level 6 h after a baseline measurement. Measurements and Main Results: The 543 patients (mean age, 65 ± 16 yr; 72.6% male) had a mean lactate clearance of 42.4% ± 53.7%. Overall 30-day survival and good neurologic outcome were 47.1% and 27.4%, respectively. The survival proportion increased with increasing lactate clearance (quartile 1, 29.4%; quartile 2, 42.6%; quartile 3, 51.5%; quartile 4, 65.2%; p < 0.001). Multivariate logistic regression analysis showed that lactate clearance quartile was an independent predictor of the 30-day survival and good neurologic outcome. In the Cox proportional hazards model, the frequency of mortality during 30 days was significantly higher for patients with lactate clearance in quartile 1 (hazard ratio, 3.12; 95% CI, 2.14-4.53), quartile 2 (hazard ratio, 2.13; 95% CI, 1.46-3.11), and quartile 3 (hazard ratio, 1.49; 95% CI, 1.01-2.19) than those with lactate clearance in quartile 4. Furthermore, multivariate logistic regression analysis revealed that lactate clearance was a significant predictor of good neurologic outcome at 30 days after hospital admission. Conclusions: Effective lactate reduction over the first 6 hours of postcardiac arrest care was associated with survival and good neurologic outcome independently of the initial lactate level.

Original languageEnglish
Pages (from-to)e559-e566
JournalCritical Care Medicine
Volume45
Issue number6
DOIs
Publication statusPublished - 2017 Jan 1

Fingerprint

Multicenter Studies
Observational Studies
Lactic Acid
Nervous System
Out-of-Hospital Cardiac Arrest
Survival
Logistic Models
Regression Analysis
Proportional Hazards Models
Resuscitation
Japan
Emergencies
Mortality

Keywords

  • Cardiac arrest
  • Hypoxic brain injury
  • Ischemiareperfusion
  • Lactate clearance
  • Shock

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

@article{99d298e907634004ab1889cb9edd6232,
title = "Early lactate clearance is associated with improved outcomes in patients with postcardiac arrest syndrome: A prospective, multicenter observational study (SOS-KANTO 2012 study)",
abstract = "Objectives: To determine whether early lactate reduction is associated with improved survival and good neurologic outcome in patients with out-of-hospital cardiac arrest. Design: Ad hoc data analysis of a prospective, multicenter observational study. Setting: Out-of-hospital cardiac arrest patients at 67 emergency hospitals in Kanto, Japan between January 2012 and March 2013. Patients: Adult patients with out-of-hospital cardiac arrest admitted to the hospital after successful resuscitation were identified. Interventions: Blood lactate concentrations were measured at hospital admission and 6 h after hospital admission. Early lactate clearance was defined as the percent change in lactate level 6 h after a baseline measurement. Measurements and Main Results: The 543 patients (mean age, 65 ± 16 yr; 72.6{\%} male) had a mean lactate clearance of 42.4{\%} ± 53.7{\%}. Overall 30-day survival and good neurologic outcome were 47.1{\%} and 27.4{\%}, respectively. The survival proportion increased with increasing lactate clearance (quartile 1, 29.4{\%}; quartile 2, 42.6{\%}; quartile 3, 51.5{\%}; quartile 4, 65.2{\%}; p < 0.001). Multivariate logistic regression analysis showed that lactate clearance quartile was an independent predictor of the 30-day survival and good neurologic outcome. In the Cox proportional hazards model, the frequency of mortality during 30 days was significantly higher for patients with lactate clearance in quartile 1 (hazard ratio, 3.12; 95{\%} CI, 2.14-4.53), quartile 2 (hazard ratio, 2.13; 95{\%} CI, 1.46-3.11), and quartile 3 (hazard ratio, 1.49; 95{\%} CI, 1.01-2.19) than those with lactate clearance in quartile 4. Furthermore, multivariate logistic regression analysis revealed that lactate clearance was a significant predictor of good neurologic outcome at 30 days after hospital admission. Conclusions: Effective lactate reduction over the first 6 hours of postcardiac arrest care was associated with survival and good neurologic outcome independently of the initial lactate level.",
keywords = "Cardiac arrest, Hypoxic brain injury, Ischemiareperfusion, Lactate clearance, Shock",
author = "{SOS-KANTO 2012 study group} and Kei Hayashida and Masaru Suzuki and Naohiro Yonemoto and Shingo Hori and Tomoyoshi Tamura and Atsushi Sakurai and Yoshio Tahara and Ken Nagao and Arino Yaguchi and Naoto Morimura",
year = "2017",
month = "1",
day = "1",
doi = "10.1097/CCM.0000000000002307",
language = "English",
volume = "45",
pages = "e559--e566",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Early lactate clearance is associated with improved outcomes in patients with postcardiac arrest syndrome

T2 - A prospective, multicenter observational study (SOS-KANTO 2012 study)

AU - SOS-KANTO 2012 study group

AU - Hayashida, Kei

AU - Suzuki, Masaru

AU - Yonemoto, Naohiro

AU - Hori, Shingo

AU - Tamura, Tomoyoshi

AU - Sakurai, Atsushi

AU - Tahara, Yoshio

AU - Nagao, Ken

AU - Yaguchi, Arino

AU - Morimura, Naoto

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Objectives: To determine whether early lactate reduction is associated with improved survival and good neurologic outcome in patients with out-of-hospital cardiac arrest. Design: Ad hoc data analysis of a prospective, multicenter observational study. Setting: Out-of-hospital cardiac arrest patients at 67 emergency hospitals in Kanto, Japan between January 2012 and March 2013. Patients: Adult patients with out-of-hospital cardiac arrest admitted to the hospital after successful resuscitation were identified. Interventions: Blood lactate concentrations were measured at hospital admission and 6 h after hospital admission. Early lactate clearance was defined as the percent change in lactate level 6 h after a baseline measurement. Measurements and Main Results: The 543 patients (mean age, 65 ± 16 yr; 72.6% male) had a mean lactate clearance of 42.4% ± 53.7%. Overall 30-day survival and good neurologic outcome were 47.1% and 27.4%, respectively. The survival proportion increased with increasing lactate clearance (quartile 1, 29.4%; quartile 2, 42.6%; quartile 3, 51.5%; quartile 4, 65.2%; p < 0.001). Multivariate logistic regression analysis showed that lactate clearance quartile was an independent predictor of the 30-day survival and good neurologic outcome. In the Cox proportional hazards model, the frequency of mortality during 30 days was significantly higher for patients with lactate clearance in quartile 1 (hazard ratio, 3.12; 95% CI, 2.14-4.53), quartile 2 (hazard ratio, 2.13; 95% CI, 1.46-3.11), and quartile 3 (hazard ratio, 1.49; 95% CI, 1.01-2.19) than those with lactate clearance in quartile 4. Furthermore, multivariate logistic regression analysis revealed that lactate clearance was a significant predictor of good neurologic outcome at 30 days after hospital admission. Conclusions: Effective lactate reduction over the first 6 hours of postcardiac arrest care was associated with survival and good neurologic outcome independently of the initial lactate level.

AB - Objectives: To determine whether early lactate reduction is associated with improved survival and good neurologic outcome in patients with out-of-hospital cardiac arrest. Design: Ad hoc data analysis of a prospective, multicenter observational study. Setting: Out-of-hospital cardiac arrest patients at 67 emergency hospitals in Kanto, Japan between January 2012 and March 2013. Patients: Adult patients with out-of-hospital cardiac arrest admitted to the hospital after successful resuscitation were identified. Interventions: Blood lactate concentrations were measured at hospital admission and 6 h after hospital admission. Early lactate clearance was defined as the percent change in lactate level 6 h after a baseline measurement. Measurements and Main Results: The 543 patients (mean age, 65 ± 16 yr; 72.6% male) had a mean lactate clearance of 42.4% ± 53.7%. Overall 30-day survival and good neurologic outcome were 47.1% and 27.4%, respectively. The survival proportion increased with increasing lactate clearance (quartile 1, 29.4%; quartile 2, 42.6%; quartile 3, 51.5%; quartile 4, 65.2%; p < 0.001). Multivariate logistic regression analysis showed that lactate clearance quartile was an independent predictor of the 30-day survival and good neurologic outcome. In the Cox proportional hazards model, the frequency of mortality during 30 days was significantly higher for patients with lactate clearance in quartile 1 (hazard ratio, 3.12; 95% CI, 2.14-4.53), quartile 2 (hazard ratio, 2.13; 95% CI, 1.46-3.11), and quartile 3 (hazard ratio, 1.49; 95% CI, 1.01-2.19) than those with lactate clearance in quartile 4. Furthermore, multivariate logistic regression analysis revealed that lactate clearance was a significant predictor of good neurologic outcome at 30 days after hospital admission. Conclusions: Effective lactate reduction over the first 6 hours of postcardiac arrest care was associated with survival and good neurologic outcome independently of the initial lactate level.

KW - Cardiac arrest

KW - Hypoxic brain injury

KW - Ischemiareperfusion

KW - Lactate clearance

KW - Shock

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U2 - 10.1097/CCM.0000000000002307

DO - 10.1097/CCM.0000000000002307

M3 - Article

C2 - 28328649

AN - SCOPUS:85015917842

VL - 45

SP - e559-e566

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

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