Limited Prognostic Value of 12-Hour Lactate Clearance After Cardiac Arrest: A Retrospective Observational Study

Öz

Abstract Purpose: This study aimed to evaluate the association between 12-hour lactate clearance and mortality in adult patients who achieved return of spontaneous circulation (ROSC) after cardiopulmonary arrest and were monitored in the intensive care unit. Methods: This retrospective study included adult patients admitted to the intensive care unit after cardiopulmonary arrest between January 2023 and January 2025. Demographic data, cardiopulmonary resuscitation (CPR) duration, and serum lactate measurements were obtained from electronic medical records. Lactate levels measured at intensive care unit admission were recorded as baseline values. Lactate clearance was calculated in patients with available baseline and 12-hour lactate measurements. Patients who died within the first 12 hours were included in early mortality analyses but excluded from lactate clearance analyses. The predictive value of baseline lactate was assessed using receiver operating characteristic (ROC) analysis, and multivariable logistic regression analysis was performed in patients with calculable lactate clearance. Results: A total of 229 patients were included, of whom 180 (78.6%) died during intensive care unit stay. Baseline lactate levels were markedly elevated in patients who died within the first 12 hours (median 14.1 mmol/L; IQR 9.9–16.0). Mortality was 79.5% in patients with negative lactate clearance and 69.9% in those with positive clearance. Lactate clearance was not independently associated with mortality. Baseline lactate demonstrated good predictive performance for 12-hour mortality (AUC = 0.75) and moderate performance for intensive care unit mortality (AUC = 0.69). Conclusion: Admission lactate levels were effective predictors of early mortality, whereas lactate clearance was not independently associated with mortality. Keywords: Cardiopulmonary arrest; Lactate clearance; Mortality; Intensive care

Anahtar Kelimeler

• Cardiopulmonary arrest
• Lactate clearance
• Mortality
• Intensive care

Etik Beyan

Ethical approval for this study was obtained from the Clinical Research Ethics Committee of Elazığ Fethi Sekin City Hospital (18 September 2025; Decision No: 2025/15-11). The study followed a retrospective observational design, with all patient data analyzed in anonymized form and without the implementation of any additional interventions. The study was conducted in accordance with the principles of the Declaration of Helsinki. This study was reported in compliance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for observational studies. This study received no external funding. The authors declare no conflicts of interest.

Kardiyopulmoner Arrest Sonrası 12 Saatlik Laktat Klirensinin Sınırlı Prognostik Değeri: Retrospektif Gözlemsel Bir Çalışma

Öz

Özet Amaç: Bu çalışmanın amacı, kardiyopulmoner arrest sonrası spontan dolaşımın geri dönüşü (ROSC) sağlanan ve yoğun bakım ünitesinde izlenen erişkin hastalarda 12 saatlik laktat klirensi ile mortalite arasındaki ilişkiyi değerlendirmektir. Yöntemler: Bu retrospektif çalışma, Ocak 2023 ile Ocak 2025 tarihleri arasında kardiyopulmoner arrest sonrası yoğun bakım ünitesine kabul edilen erişkin hastaları kapsamaktadır. Demografik veriler, kardiyopulmoner resüsitasyon (CPR) süresi ve serum laktat ölçümleri elektronik hasta kayıtlarından elde edilmiştir. Yoğun bakım ünitesine kabul sırasında ölçülen laktat düzeyleri başlangıç laktat değeri olarak kaydedilmiştir. Laktat klirensi, başlangıç ve 12. saat laktat ölçümleri mevcut olan hastalarda hesaplanmıştır. İlk 12 saat içinde kaybedilen hastalar erken mortalite analizlerine dâhil edilmiş, ancak laktat klirensi analizlerinden çıkarılmıştır. Başlangıç laktat düzeyinin prediktif değeri alıcı işletim karakteristiği (ROC) analizi ile değerlendirilmiş; çok değişkenli lojistik regresyon analizi yalnızca laktat klirensi hesaplanabilen hastalarda yapılmıştır. Bulgular: Toplam 229 hasta çalışmaya dâhil edilmiş ve bunların 180’i (%78,6) yoğun bakım ünitesi yatışı sırasında kaybedilmiştir. İlk 12 saat içinde ölen hastalarda başlangıç laktat düzeyleri belirgin şekilde yüksektir (medyan 14,1 mmol/L; IQR 9,9–16,0). Negatif laktat klirensi olan hastalarda mortalite %79,5, pozitif klirensi olanlarda %69,9 olarak bulunmuştur. Laktat klirensi mortalite ile bağımsız olarak ilişkili bulunmamıştır. Başlangıç laktat düzeyi, 12 saatlik mortaliteyi öngörmede iyi (AUC = 0,75) ve yoğun bakım ünitesi mortalitesini öngörmede orta düzeyde (AUC = 0,69) performans göstermiştir. Sonuç: Yoğun bakıma kabul sırasında ölçülen laktat düzeyleri erken mortalitenin öngörülmesinde etkili iken, laktat klirensi mortalite ile bağımsız olarak ilişkili bulunmamıştır.

Anahtar Kelimeler

• Kardiyopulmoner arrest
• Laktat klirensi
• Mortalite
• Yoğun bakım

Etik Beyan

Bu çalışma için etik kurul onayı, Elazığ Fethi Sekin Şehir Hastanesi Klinik Araştırmalar Etik Kurulu’ndan alınmıştır (18 Eylül 2025; Karar No: 2025/15-11). Çalışma retrospektif gözlemsel tasarımda yürütülmüş olup, tüm hasta verileri anonimleştirilmiş şekilde analiz edilmiş ve herhangi bir ek müdahalede bulunulmamıştır. Çalışma, Helsinki Bildirgesi ilkelerine uygun olarak gerçekleştirilmiştir. Ayrıca bu çalışma, gözlemsel çalışmalar için STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) raporlama kılavuzuna uygun olarak raporlanmıştır. Bu çalışma için herhangi bir dış finansman desteği alınmamıştır. Yazarlar çıkar çatışması olmadığını beyan etmektedir.

Kaynakça

1. Nolan JP, Sandroni C, Böttiger BW, et al. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2021: post-resuscitation care. Intensive Care Med. 2021;47(4):369-421.
2. Hirsch KG, Abella BS, Amorim E, et al. Critical care management of patients after cardiac arrest: a scientific statement from the American Heart Association and Neurocritical Care Society. Circulation. 2024;149(2).
3. Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181-1247.
4. Patel NT, Carr CT, Hopson CM, et al. Lactate and pH as independent biomarkers for prognosticating meaningful post-out-of-hospital cardiac arrest outcomes: a systematic review and meta-analysis. J Clin Med. 2025;14(7):2244.
5. Thevathasan T, Gregers E, Rasalingam Mørk S, et al. Lactate and lactate clearance as predictors of one-year survival in extracorporeal cardiopulmonary resuscitation. Resuscitation. 2024;198:110149.
6. Shime N, Nakada T, Yatabe T, et al. The Japanese clinical practice guidelines for management of sepsis and septic shock 2024. J Intensive Care. 2025;13(1):15.
7. Jouffroy R, Léguillier T, Gilbert B, et al. Prehospital lactate clearance is associated with reduced mortality in patients with septic shock. Am J Emerg Med. 2021;46:367-373.
8. Lonsain WS, De Lausnay L, Wauters L, et al. The prognostic value of early lactate clearance for survival after out-of-hospital cardiac arrest. Am J Emerg Med. 2021;46:56-62.

9. Choi SY, Oh SH, Park KN, et al. Association between early lactate-related variables and 6-month neurological outcome in out-of-hospital cardiac arrest patients. Am J Emerg Med. 2024;78:62-68.
10. Huang HH, Lin CH, Chiu YW, et al. Early lactate kinetics predicts survival and neurological outcomes after out-of-hospital cardiac arrest: a retrospective cohort study. BMC Emerg Med. 2025;25(1):231.
11. Ryoo SM, Kim YJ, Sohn CH, et al. Prognostic abilities of serial neuron-specific enolase and lactate and their combination in cardiac arrest survivors during targeted temperature management. J Clin Med. 2020;9(1):159.
12. Nishioka N, Kobayashi D, Izawa J, et al. Association between serum lactate during cardiopulmonary resuscitation and survival in adult out-of-hospital cardiac arrest. Circulation. 2019;140(Suppl_2).
13. Nakamura E, Aoki T, Endo Y, et al. Organ-specific mitochondrial alterations following ischemia–reperfusion injury in post-cardiac arrest syndrome: a comprehensive review. Life. 2024;14(4):477.
14. Okuma Y, Becker LB, Hayashida K, et al. Effects of post-resuscitation normoxic therapy on oxygen-sensitive oxidative stress in a rat model of cardiac arrest. J Am Heart Assoc. 2021;10(7):e018773.
15. Jozwiak M, Bougouin W, Geri G, et al. Post-resuscitation shock: recent advances in pathophysiology and treatment. Ann Intensive Care. 2020;10(1):170.
16. Falter F, Tisherman SA, Perrino AC, et al. Serial lactate in clinical medicine – a narrative review. J Intensive Care Med. 2026;41(3):175-185.
17. Lee SG, Song J, Park DW, et al. Prognostic value of lactate levels and lactate clearance in sepsis and septic shock with initial hyperlactatemia. Medicine (Baltimore). 2021;100(7):e24835.
18. Rehman F, Zafar SB, Aziz A, et al. Early lactate clearance as a determinant of survival in patients with sepsis: findings from a low-resource country. J Crit Care Med. 2023;9(1):30-38.
19. Lazzarin T, Tonon CR, Martins D, et al. Post-cardiac arrest: mechanisms, management, and future perspectives. J Clin Med. 2022;12(1):259.
20. Sugimoto M, Takayama W, Inoue A, et al. Impact of lactate clearance on clinical and neurological outcomes of patients with out-of-hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation. Crit Care Med. 2024;52(7):e341-e350.
21. Levy B, Girerd N, Baudry G, et al. Serial daily lactate levels association with 30-day outcome in cardiogenic shock patients treated with VA-ECMO. Ann Intensive Care. 2024;14(1):43.
22. Klemm G, Markart S, Hermann A, et al. Lactate as a predictor of 30-day mortality in cardiogenic shock. J Clin Med. 2024;13(7):1932.
23. Wu X, Yuan L, Xu J, et al. Normalized lactate load as an independent prognostic indicator in patients with cardiogenic shock. BMC Cardiovasc Disord. 2024;24(1):348.
24. Legrand M, Van Der Horst ICC, De Jong A. Serial lactate measurements to guide resuscitation: more evidence not to? Intensive Care Med. 2024;50(5):728-730.
25. Liu L, Ma Q, Yu G, et al. The association between the lactate to albumin ratio and all-cause mortality in cardiac arrest patients: an analysis of the MIMIC-IV database. Eur J Med Res. 2025;30(1):712.