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Persistent hyperlactaemia is related to high rates of in-hospital adverse events and poor outcome in acute heart failure.
Kardiol Pol. 2019 Feb 14;:
Authors: Biegus J, Zymliński R, Gajewski P, Sokolski M, Siwołowski P, Sokolska J, Swoboda K, Banasiak M, Banasiak W, Ponikowski P
Abstract
BACKGROUND: Although lactate is a well-established marker in intensive care, our understanding of its utility in acute heart failure (AHF) is modest and is based on studies with a single measurement of the marker.
AIM: Our aim was to investigate whether persistent elevation of lactate during hospitalisation is related to a higher risk of adverse events.
METHODS: We conducted a prospective study to assess AHF patients hospitalised in one cardiac centre. The definition of persistent hyperlactaemia was based on two measurements of the marker (on admission and at 24 hours of hospitalisation) and was defined as lactate elevation (≥2mmol/L) at both time points.
RESULTS: The population consisted of 222 patients with mean age, ejection fraction and creatinine on admission: 70 ± 13 (years), 37 ± 16 (%), 1.36 ± 0.51 (mg/dL), respectively. The percentage of patients with elevated lactates on admission, at 24 hours of hospitalisation and persistent hyperlactaemia was 47%, 35% and 24%, respectively. The group with persistent hyperlactaemia did not differ in most clinical and laboratory variables from the rest of the population. Patients with persistent hyperlactaemia had significantly higher rate of adverse events during hospitalisation: worsening of heart failure (22.6% vs 6.5%), inotrope use (22.6% vs 5.3%), increase of NTproBNP at 48hours of hospitalisation (30% vs 18%), all p<0.05. Persistent hyperlactaemia was an independent predictor of one-year mortality; hazard ratio (95% confidence interval): 2.5 [1.5-4.3], p<0.001.
CONCLUSIONS: Persistent hyperlactaemia within the first 24 hours of hospitalisation is an ominous sign in AHF and is related to higher rates of in-hospital adverse events and higher one-year mortality.
PMID: 30761511 [PubMed - as supplied by publisher]