Objective:

To synthesize evidence on the pathophysiology, prognostic value, and clinical interpretation of serum lactate in patients with cardiogenic shock.

Approach:

• Evidence Review: Investigators reviewed clinical trials, registries, observational studies, and studies involving temporary mechanical circulatory support.

Key Findings:

• Admission lactate is associated with shock severity and mortality.
• Lactate thresholds of approximately 3 to 3.5 mmol/L indicate higher risk of short-term mortality.
• A baseline lactate level of 5 mmol/L predicts 30-day mortality in acute myocardial infarction-related cardiogenic shock.
• Serial lactate monitoring reflects metabolic recovery and response to therapy.
• Lactate measured 8 hours after presentation predicts 30-day mortality more accurately than baseline lactate.
• Reductions in lactate during the first 12 to 24 hours are associated with improved survival.
• Complete lactate clearance is a strong predictor of survival.
• Persistent hyperlactatemia despite adequate device flow indicates poor outcomes.

Interpretation:

Lactate levels reflect disease severity and should be interpreted in the context of clinical conditions, not as standalone measures.

Limitations:

• The review is a narrative synthesis of heterogeneous sources.
• Lactate values should be interpreted within the broader clinical context.

Conclusion:

Trajectory-based lactate assessment may provide important information for risk stratification and therapeutic guidance.

Sources:

• Annals of Intensive Care