Clinical Scorecard: Lactate Biomarker May Predict Outcomes in Cardiogenic Shock

At a Glance

Key Highlights

• Admission lactate levels are associated with shock severity and mortality.
• Lactate thresholds of 3 to 3.5 mmol/L indicate higher short-term mortality risk.
• Serial lactate monitoring reflects metabolic recovery and response to therapy.
• Early lactate clearance is a strong predictor of survival post-VA-ECMO initiation.
• Lactate should be interpreted as a dynamic biomarker reflecting metabolic stress and clearance.

Guideline-Based Recommendations

Diagnosis

• Use admission lactate levels to assess shock severity.

Management

• Monitor lactate levels serially to guide treatment and assess recovery.

Monitoring & Follow-up

• Track lactate clearance within the first 24 hours for survival prediction.

Risks

• Persistent hyperlactatemia despite adequate device flow is associated with poor outcomes.

Patient & Prescribing Data

Patients undergoing treatment for cardiogenic shock, including those receiving VA-ECMO.

Epinephrine may elevate lactate levels, complicating clinical interpretation.

Clinical Best Practices

• Integrate lactate values with clinical context for accurate assessment.
• Consider trajectory-based lactate assessment for risk stratification.

Related Resources & Content

• Annals of Intensive Care