Background Recent studies have shown improved outcomes in
cardiogenic shock through protocols directed toward early identification and initiation of mechanical circulatory support. However, objective therapeutic targets-based on clinical and/or laboratory data-to guide real-time clinical decision making are lacking.
Lactate clearance has been suggested as a potential treatment target because of its independent association with mortality. Methods and Results In a post hoc analysis of the DOREMI (
Dobutamine Compared to
Milrinone in the Treatment of
Cardiogenic Shock) trial-a randomized, double-blind, controlled trial comparing
milrinone to
dobutamine in the treatment of
cardiogenic shock-we used prospectively collected
lactate data to evaluate
lactate clearance as a
surrogate marker for in-hospital mortality. In total, 82 (57.7%) patients survived to hospital discharge (survivors). In multivariate logistic regression analysis, complete
lactate clearance, percentage
lactate clearance, and percentage
lactate clearance per hour were independently associated with survival beginning as early as 8 hours after enrollment. Complete
lactate clearance was the strongest predictor of survival at all time points, with odds ratios ranging between 2.46 (95% CI, 1.09-5.55; P=0.03) at 8 hours to 5.44 (95% CI, 2.14-13.8; P<0.01) at 24 hours. Conclusions Complete
lactate clearance is a strong and independent predictor of in-hospital survival in patients with
cardiogenic shock. Together with previously published data, these results further support the validity of
lactate clearance as an appropriate surrogate for mortality and as a potential therapeutic target in future
cardiogenic shock trials. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03207165.