# Normalized lactate load as an independent prognostic indicator in patients with cardiogenic shock

## TL;DR

This study shows that tracking lactate levels over time can better predict survival in patients with heart failure than single measurements.

## Contribution

Normalized lactate load is shown to be a superior and independent predictor of in-hospital mortality in cardiogenic shock patients.

## Key findings

- Normalized lactate load had a higher AUC (0.675) than first, maximum, and mean lactate values.
- Normalized lactate load showed comparable predictive power to the SOFA score.
- Normalized lactate load is independently associated with in-hospital mortality in CS patients.

## Abstract

Early prognosis evaluation is crucial for decision-making in cardiogenic shock (CS) patients. Dynamic lactate assessment, for example, normalized lactate load, has been a better prognosis predictor than single lactate value in septic shock. Our objective was to investigate the correlation between normalized lactate load and in-hospital mortality in patients with CS.

Data were extracted from the Medical Information Mart for Intensive Care (MIMIC)-IV database. The calculation of lactate load involved the determination of the cumulative area under the lactate curve, while normalized lactate load was computed by dividing the lactate load by the corresponding period. Receiver Operating Characteristic (ROC) curves were constructed, and the evaluation of areas under the curves (AUC) for various parameters was performed using the DeLong test.

Our study involved a cohort of 1932 CS patients, with 687 individuals (36.1%) experiencing mortality during their hospitalization. The AUC for normalized lactate load demonstrated significant superiority compared to the first lactate (0.675 vs. 0.646, P < 0.001), maximum lactate (0.675 vs. 0.651, P < 0.001), and mean lactate (0.675 vs. 0.669, P = 0.003). Notably, the AUC for normalized lactate load showed comparability to that of the Sequential Organ Failure Assessment (SOFA) score (0.675 vs. 0.695, P = 0.175).

The normalized lactate load was an independently associated with the in-hospital mortality among CS patients.

The online version contains supplementary material available at 10.1186/s12872-024-04013-8.