Identification of a High-Risk Phenotype in 24-Hour Conditional Survivors of PCAS

Overview

This study identifies a high-risk phenotype in 24-hour conditional survivors of post-cardiac arrest syndrome (PCAS) through the interaction of serial lactate and procalcitonin levels.

Background

Post-cardiac arrest syndrome (PCAS) is associated with high mortality and morbidity. Traditional biomarkers, such as lactate and procalcitonin, have shown potential in predicting outcomes, but their combined effects in a dynamic context remain underexplored. This study aims to enhance risk stratification in this critically ill population.

Data Highlights

Key Findings

• The in-hospital mortality rate among 24-hour conditional survivors of PCAS was 70.9%.
• Non-survivors had higher rates of non-shockable rhythms and longer CPR durations.
• Persistent hyperlactatemia at 48 hours was an independent predictor of mortality (OR: 1.92).
• The CART analysis identified a high-risk phenotype with T0 lactate >5 mmol/L and T24 PCT > 5.5 ng/mL, associated with a 92% mortality risk.
• The CART model demonstrated excellent calibration and comparable discrimination to logistic regression.

Clinical Implications

Monitoring serial lactate and procalcitonin levels can aid in identifying high-risk patients in the post-cardiac arrest setting.

Conclusion

The integration of lactate and procalcitonin kinetics through CART analysis provides a tool for identifying high-risk patients among 24-hour conditional survivors of PCAS.

Related Resources & Content

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6. Lactate and pH as Independent Biomarkers for Prognosticating Meaningful Post-out-of-Hospital Cardiac Arrest Outcomes: A Systematic Review and Meta-Analysis - PMC, 2025 -- Lactate and pH as Independent Biomarkers
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8. AHA Guidelines on Post-Cardiac Arrest Care
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10. Lactate and pH as Independent Biomarkers for Prognosticating Meaningful Post-out-of-Hospital Cardiac Arrest Outcomes: A Systematic Review and Meta-Analysis - PMC
11. Innate Immune Response After Cardiac Arrest (INNATUS): A Study Protocol for an Observational Single‐Center Pilot Study - Seppä - 2025 - Acta Anaesthesiologica Scandinavica - Wiley Online Library
12. The dynamic pathophysiology of post cardiac arrest brain injury: "time is brain" - PubMed