title: Validation of lactate level as a predictor of early mortality in acute decompensated heart failure patients who entered intensive care unit.
abstract: BACKGROUND
  The significance of routine measurement of lactate level is unclear in patients with critical acute decompensated heart failure (ADHF).
  
  
  RESULTS
  Consecutive 754 patients who were admitted to the intensive care unit (ICU) in our hospital from January 2007 to March 2012 and given a diagnosis of ADHF were eligible for retrospective entry into the registry. Lactate level was measured on admission from routine arterial blood sample and we investigated by comparing the lactate level and parameters of conventional in-hospital mortality predictors. Among the patients, 88 (12%) died during hospitalization. The lactate level had great power to predict in-hospital mortality, as suggested by the c-statistics of 0.71. The occurrence of in-hospital death was more pronounced in patients with high levels of lactate (>3.2mmol/l) and the tendency was observed in patients in both the acute coronary syndrome (ACS) group and non-ACS group. In multivariate analysis, elevated lactate levels remained an independent predictor of in-hospital death (odds ratio, 2.14; 95% confidence interval, 1.10-4.21; p=0.03).
  
  
  CONCLUSIONS
  Elevated levels of arterial lactate on admission were related to worse in-hospital mortality in patients with ADHF either with or without ACS, suggesting that the presence of high lactate in patients who enter the ICU with ADHF could help stratify the initial risk of early mortality.
authors: Department of Cardiology, Tsuchiya General Hospital, Hiroshima, Japan. Electronic address: hiromi-k@tg7.so-net.ne.jp.
authors: Tomoharu
authors: T
authors: Kawase
authors: Division of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan.
authors: Mamoru
authors: M
authors: Toyofuku
authors: Department of Cardiology, Tsuchiya General Hospital, Hiroshima, Japan.
authors: Tasuku
authors: T
authors: Higashihara
authors: Department of Cardiology, Tsuchiya General Hospital, Hiroshima, Japan.
authors: Yousaku
authors: Y
authors: Okubo
authors: Department of Cardiology, Tsuchiya General Hospital, Hiroshima, Japan.
authors: Lisa
authors: L
authors: Takahashi
authors: Department of Cardiology, Tsuchiya General Hospital, Hiroshima, Japan.
authors: Yuzo
authors: Y
authors: Kagawa
authors: Department of Cardiology, Tsuchiya General Hospital, Hiroshima, Japan.
authors: Kenichi
authors: K
authors: Yamane
authors: Department of Cardiology, Tsuchiya General Hospital, Hiroshima, Japan.
authors: Shinji
authors: S
authors: Mito
authors: Department of Cardiology, Tsuchiya General Hospital, Hiroshima, Japan.
authors: Hiromichi
authors: H
authors: Tamekiyo
authors: Department of Cardiology, Tsuchiya General Hospital, Hiroshima, Japan.
authors: Masaya
authors: M
authors: Otsuka
authors: Department of Cardiology, Tsuchiya General Hospital, Hiroshima, Japan.
authors: Tomokazu
authors: T
authors: Okimoto
authors: Department of Cardiology, Tsuchiya General Hospital, Hiroshima, Japan.
authors: Yuji
authors: Y
authors: Muraoka
authors: Department of Cardiology, Tsuchiya General Hospital, Hiroshima, Japan.
authors: Yoshiko
authors: Y
authors: Masaoka
authors: Department of Cardiology, Tsuchiya General Hospital, Hiroshima, Japan.
authors: Nobuo
authors: N
authors: Shiode
authors: Department of Cardiology, Tsuchiya General Hospital, Hiroshima, Japan.
authors: Yasuhiko
authors: Y
authors: Hayashi
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000401:mortality*; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D012306:Risk
chemical_list: D015415:Biomarkers; D019344:Lactic Acid
keywords: Acute decompensated heart failure; Biomarker; Lactate; Mortality