• Tomoharu Kawase, Mamoru Toyofuku, Tasuku Higashihara, Yousaku Okubo, Lisa Takahashi, Yuzo Kagawa, Kenichi Yamane, Shinji Mito, Hiromichi Tamekiyo, Masaya Otsuka, Tomokazu Okimoto, Yuji Muraoka, Yoshiko Masaoka, Nobuo Shiode, and Yasuhiko Hayashi.
• Department of Cardiology, Tsuchiya General Hospital, Hiroshima, Japan. Electronic address: hiromi-k@tg7.so-net.ne.jp.
• J Cardiol. 2015 Feb 1;65(2):164-70.

BackgroundThe significance of routine measurement of lactate level is unclear in patients with critical acute decompensated heart failure (ADHF).Methods And ResultsConsecutive 754 patients who were admitted to the intensive care unit (ICU) in our hospital from January 2007 to March 2012 and given a diagnosis of ADHF were eligible for retrospective entry into the registry. Lactate level was measured on admission from routine arterial blood sample and we investigated by comparing the lactate level and parameters of conventional in-hospital mortality predictors. Among the patients, 88 (12%) died during hospitalization. The lactate level had great power to predict in-hospital mortality, as suggested by the c-statistics of 0.71. The occurrence of in-hospital death was more pronounced in patients with high levels of lactate (>3.2mmol/l) and the tendency was observed in patients in both the acute coronary syndrome (ACS) group and non-ACS group. In multivariate analysis, elevated lactate levels remained an independent predictor of in-hospital death (odds ratio, 2.14; 95% confidence interval, 1.10-4.21; p=0.03).ConclusionsElevated levels of arterial lactate on admission were related to worse in-hospital mortality in patients with ADHF either with or without ACS, suggesting that the presence of high lactate in patients who enter the ICU with ADHF could help stratify the initial risk of early mortality.Copyright © 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

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