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 language | English |
|---|---|
| Pages (from-to) | e559-e566 |
| Journal | Critical Care Medicine |
| Volume | 45 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - 2017 Jan 1 |
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Keywords
- Cardiac arrest
- Hypoxic brain injury
- Ischemiareperfusion
- Lactate clearance
- Shock
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine
Cite this
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.
In: Critical Care Medicine, Vol. 45, No. 6, 01.01.2017, p. e559-e566.Research output: Contribution to journal › Article
}
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
UR - http://www.scopus.com/inward/record.url?scp=85015917842&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85015917842&partnerID=8YFLogxK
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
IS - 6
ER -