Blood Lactate or Lactate Clearance: Which Is Robust to Predict the Neurological Outcomes after Cardiac Arrest? A Systematic Review and Meta-Analysis.

Bao-Chun Zhou,Li-Jun Liu,Chun-Feng Liu,Jian-Jun Zhu,Zheng Zhang

doi:10.1155/2018/8014213

Abstract

Aims Lactate and lactate clearance were supposed to be associated with cardiac arrest outcomes, but studies obtained different results. Thus, we conducted this meta-analysis to investigate the association between lactate or lactate clearance and neurological outcomes and their usefulness for prediction of neurological outcomes. Methods We conducted a systematic search in PubMed, Web of science, EMBASE, Medline, and Google Scholar until May 1, 2018, for relevant studies. Studies reporting lactate, lactate clearance on admission, or other time points after admission associated with neurological outcomes were included in our analysis. Pooled effect date was shown as weighed mean difference (WMD) and 95% confidence interval (CI). To measure the usefulness of lactate on admission to predict neurological outcomes, we also pooled the data of diagnostic test. Results 23 studies involving 6720 cardiac arrest (CA) patients were included. Results from our analysis indicated that patients with good neurological outcomes tended to have a lower lactate level on admission (WMD: -2.66 mmol/L, 95%CI: -3.39 to -1.93) and 12h, 24h, and 48h after admission (P<0.001). Furthermore, the pooled AUC for lactate level on admission to predict neurological outcomes was 0.77 (95%CI: 0.73-0.80). However, a significant association between lactate clearance and neurological outcomes was only found in 24h but not 12h lactate clearance rate. Conclusions Lactate levels on admission and all time points up to 48h were associated with neurological outcomes after CA, whereas the association between lactate clearance and neurological outcomes was not so stable. Lactate was a more robust surrogate marker than lactate clearance to predict neurological outcomes after CA.

Highlights

Cardiac arrest (CA) presents a serious public health concern with high mortality cause by various pathogenesis such as anoxia, drug, electrolyte disturbance, low temperature, and hypoglycemia [1]
Six articles reported lactate levels related to survival outcome; 4 articles did not provide sufficient data; 2 articles carried on CA patients under the age of 18; 2 articles included trauma cardiac arrest patients; 2 articles were letter to author; 1 was system review; and 1 was study abstract
To the best of our knowledge, this was the first meta-analysis paying a close attention to the association and prognostic value of blood lactate and lactate clearance on CA neurological outcomes through systematically reviewing 23 relevant

Summary

Introduction

Cardiac arrest (CA) presents a serious public health concern with high mortality cause by various pathogenesis such as anoxia, drug, electrolyte disturbance, low temperature, and hypoglycemia [1]. In Europe and north American, CA causes more than 600,000 cases per year [2], and the survival rate at hospital discharge is very low. Many researches have performed studies to develop tools for predicting the neurological outcomes. Biological markers such as neuron-specific enolase and S-100β protein have been demonstrated to be efficient predictors for neurological outcomes after CA. These markers need longer time for detection. Lactate and lactated clearance are supposed to be that kind of marker

Methods

Results

Conclusion