Open AccessTime‐weighted lactate as a predictor of adverse outcome in acute heart failure
Author(s) -
Bosso Giorgio,
Mercurio Valentina,
Diab Nermin,
Pagano Antonio,
Porta Giovanni,
Allegorico Enrico,
Serra Claudia,
Guiotto Giovanna,
Numis Fabio Giuliano,
Tocchetti Carlo Gabriele,
Schiraldi Fernando
Publication year - 2021
Publication title -
esc heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.787
H-Index - 25
ISSN - 2055-5822
DOI - 10.1002/ehf2.13112
Subject(s) - medicine , heart failure , hazard ratio , confidence interval , proportional hazards model , intensive care unit , cardiology
Aims The role of dynamic changes in lactate concentrations on prognosis in acute heart failure has been poorly investigated. The aim of this study was to explore the predictive value of 24 h time‐weighted lactate (LAC TW ) in patients with acute heart failure. Methods and results Ninety‐six consecutive acute heart failure patients presenting to the Emergency Department of San Paolo Hospital, Naples, Italy, were prospectively enrolled. Arterial blood lactate was measured at admission and during the following 24 h at random time intervals. LAC TW was obtained by the sum of the average lactate values among consecutive time points multiplied by the intervals between consecutive time points and dividing the sum by the total time (24 h). The outcome was a composite of need of admission to the intensive care unit, hospitalization duration >7 days, or intra‐hospital death. Admission lactate, maximum measured lactate, and LAC TW were collected. Univariate and multivariate Cox regression analysis was applied to determine the hazard ratio (HR) of developing the outcome. Forty‐three patients experienced the pre‐specified outcome. In sex‐adjusted and age‐adjusted multivariable analysis, LAC TW predicted the outcome occurrence (HR: 1.51, 95% confidence interval: 1.24, 1.84, P < 0.001). Risk stratification analysis based on LAC TW tertiles demonstrated a gradual increase in risk of developing the outcome (HR: 17.32, 95% confidence interval: 2.30, 130.23, P = 0.006) for the highest LAC TW tertile. Conclusions In acute heart failure patients, 24 h LAC TW had a significant independent predictive value for adverse intra‐hospital outcome. LAC TW could be a useful index at identifying high‐risk patients who may require a more aggressive treatment during hospitalization.