ArticleClinical research in cardiology : official journal of the German Cardiac Society2026
Prognostic value of lactate in patients with cardiogenic shock with and without cardiac arrest.
Article in Clinical research in cardiology : official journal of the German Cardiac Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundArterial lactate on admission is a well-established marker of shock severity and prognosis in infarct-related cardiogenic shock (CS). However, it remains unclear whether its prognostic value differs between patients with and without pre-hospital cardiac arrest (CA).
methodsWe performed a pooled analysis of three randomized clinical trials on CS (IABP-SHOCK II, CULPRIT-SHOCK, and ECLS-SHOCK). Patients were stratified based on the presence or absence of pre-hospital CA. Admission arterial lactate levels were categorized into tertiles: < 3.6, 3.6-7.1, and > 7.1 mmol/L. The primary endpoint was 1-year all-cause mortality.
resultsA total of 1401 patients (804 with CA and 597 without CA) were included. Higher admission lactate levels were associated with a linear increase in 1-year mortality. The prognostic performance of arterial lactate, assessed by the area under the curve (AUC), was 0.65 (95% CI 0.63-0.67). Patients with CA were more frequently represented in the highest lactate tertile compared to those without CA (31.6% vs. 8.8%). Across all tertiles, lactate levels were significantly associated with 1-year mortality, irrespective of CA status: 39.8% vs. 41.4% in the lowest tertile (p = 0.73), 48.6% vs. 50.8% in the intermediate tertile (p = 0.61), and 66.7% vs. 81.8% in the highest tertile (p = 0.0023), for CA and no-CA patients, respectively.
conclusionsAdmission arterial lactate is associated with 1-year mortality in infarct-related CS, regardless of pre-hospital CA. Although patients without CA generally had lower lactate levels, those in the highest lactate tertile experienced the highest mortality risk.
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