title: Association of serum lactate with outcome after out-of-hospital cardiac arrest treated with therapeutic hypothermia.
abstract: OBJECTIVE
  Lactate reflects hypoxic insult in many conditions and is considered as a prognosis factor. But, after cardiac arrest, its interest is still debated. Our study aimed to assess the prognosis value of lactate in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia.
  
  
  METHODS
  This retrospective observational study included out-of-hospital cardiac arrest patients treated with therapeutic hypothermia in four ICUs. Lactate levels were compared at different times during the first 24 hours according to outcome at ICU discharge and to the type of death (multiorgan or neurologic failure).
  
  
  RESULTS
  Two hundred and seventy-two patients were included, 89 good outcome and 183 poor outcome. In the latter group, 171 patients died, from multiorgan failure in 30% and neurologic failure in 70%. Lactate levels were higher in the poor compared to the good outcome patients at admission (5.4 (3.3-9.4) vs. 2.2 (1.5-3.6) mmol/L; p<0.01), 12 hours (2.5 (1.6-4.7) vs. 1.4 (1.0-2.2) mmol/L; p<0.01) and 24 hours (1.8 (1.1-2.8) vs. 1.3 (0.9-2.1) mmol/L; p<0.01). Patients succumbing from multiorgan failure exhibited higher lactate levels compared to those dying from neurologic failure at admission (7.9 (3.9-12.0) vs. 5.2 (3.3-8.8) mmol/L; p<0.01), H12 (4.9 (2.1-8.9) vs. 2.2 (1.4-3.4) mmol/L; p<0.01) and H24 (3.3 (1.8-5.5) vs. 1.4 (1.1-2.5) mmol/L; p<0.01). Initial lactate levels showed an increasing proportion of poor outcome from the first to fourth quartile.
  
  
  CONCLUSIONS
  After out-of-hospital cardiac arrest treated with therapeutic hypothermia, lactate levels during the first 24 hours seem linked with ICU outcome. Patients dying from multiorgan failure exhibit higher initial lactate concentrations than patients succumbing from neurological failure.
authors.affiliation: Medical surgical ICU, Pasteur 2 Hospital, Nice University Hospital, 30 Voie Romaine, Nice, France.
authors.forename: Jean-Christophe
authors.identifier: http://orcid.org/0000-0002-8004-4809
authors.initials: JC
authors.lastname: Orban
authors.affiliation: Medical surgical ICU, Pasteur 2 Hospital, Nice University Hospital, 30 Voie Romaine, Nice, France.
authors.forename: Michaël
authors.initials: M
authors.lastname: Novain
authors.affiliation: Medical surgical ICU, Pasteur 2 Hospital, Nice University Hospital, 30 Voie Romaine, Nice, France.
authors.forename: Florian
authors.initials: F
authors.lastname: Cattet
authors.affiliation: Medical surgical ICU, Pasteur 2 Hospital, Nice University Hospital, 30 Voie Romaine, Nice, France.
authors.forename: Rémi
authors.initials: R
authors.lastname: Plattier
authors.affiliation: Medical surgical ICU, Pasteur 2 Hospital, Nice University Hospital, 30 Voie Romaine, Nice, France.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Nefzaoui
authors.affiliation: Medical ICU, Archet Hospital, Nice University Hospital, 151 route de Saint-Antoine, Nice, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Hyvernat
authors.affiliation: Intensive Care Unit, Antibes General Hospital, 107 avenue de Nice, Antibes, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Raguin
authors.affiliation: Intensive Care Unit, Fréjus Saint-Raphaël General Hospital, 240 avenue de Saint-Lambert, Fréjus, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Kaidomar
authors.affiliation: Departments of Anesthesiology and Critical Care, Lariboisière University Hospital, 2 rue Ambroise Paré, Paris, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Kerever
authors.affiliation: Medical surgical ICU, Pasteur 2 Hospital, Nice University Hospital, 30 Voie Romaine, Nice, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Ichai
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D007362:Intensive Care Units; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D010351:Patient Discharge; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D019344:Lactic Acid