Increased blood lactate is prevalent and identifies poor prognosis in patients with acute heart failure without overt peripheral hypoperfusion

Zymliński, R. et al. (2018) Increased blood lactate is prevalent and identifies poor prognosis in patients with acute heart failure without overt peripheral hypoperfusion. European Journal of Heart Failure, 20(6), pp. 1011-1018. (doi:10.1002/ejhf.1156) (PMID:29431284)

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Abstract

Aims: Lactate is produced by anaerobic metabolism and may reflect inadequate tissue perfusion in conditions such as acute heart failure (AHF). We evaluated the prevalence and clinical significance of elevated blood lactate on admission in patients with AHF. Methods and results: We enrolled 237 patients with AHF (mean age 67 ± 12 years; 70% men) presenting without overt clinical evidence of peripheral hypoperfusion (‘warm haemodynamic profile’). Median (upper and lower quartiles) blood lactate on admission was 1.8 (1.5; 2.4) mmol/L; 103 (43%) patients had an elevated blood lactate (≥2 mmol/L). Patients with an elevated lactate had higher blood high-sensitivity troponin I [15.4 (8.5; 26.1) vs. 9.9 (4.3; 19.6) pg/mL], aspartate aminotransferase [28 (20; 44) vs 24 (19; 36) IU/L] and endothelin-1 (12.1 ± 6.2 vs. 9.3 ± 3.9 pg/mL) (all P < 0.05). In this group plasma concentration of neutrophil gelatinase-associated lipocalin increased during the first 48 h, whereas values fell for those with normal baseline lactate [1.9 (–3.2; 9.7) vs. –1.3 (–13.9; 5.6) μg/dL; P < 0.05). One-year mortality was higher amongst patients with an elevated blood lactate (36% vs. 21%; P < 0.05). After adjustment for other well-established prognostic variables, blood lactate on admission predicted poor outcome (hazard ratio 1.24, 95% confidence interval 1.08–1.41; P < 0.05). Conclusions: An elevated blood lactate on admission is common in AHF patients without overt clinical evidence of peripheral hypoperfusion and is associated with markers of organ dysfunction/damage and a worse prognosis.

Item Type:Articles
Additional Information:This research was supported by the National Science Centre (Poland), grant no. 6543/B/T02/2011/40.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cleland, Professor John
Authors: Zymliński, R., Biegus, J., Sokolski, M., Siwołowski, P., Nawrocka-Millward, S., Todd, J., Jankowska, E. A., Banasiak, W., Cotter, G., Cleland, J. G., and Ponikowski, P.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:European Journal of Heart Failure
Publisher:Wiley
ISSN:1388-9842
ISSN (Online):1879-0844
Published Online:12 February 2018
Copyright Holders:Copyright © 2018 The Authors and European Society of Cardiology
First Published:First published in European Journal of Heart Failure 20(6): 1011-1018
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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