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Meta-Analysis
. 2018 Oct 2:2018:8014213.
doi: 10.1155/2018/8014213. eCollection 2018.

Blood Lactate or Lactate Clearance: Which Is Robust to Predict the Neurological Outcomes after Cardiac Arrest? A Systematic Review and Meta-Analysis

Bao-Chun Zhou  1 , Zheng Zhang  2 , Jian-Jun Zhu  1 , Li-Jun Liu  1 , Chun-Feng Liu  3
Affiliations
Meta-Analysis

Blood Lactate or Lactate Clearance: Which Is Robust to Predict the Neurological Outcomes after Cardiac Arrest? A Systematic Review and Meta-Analysis

Bao-Chun Zhou et al. Biomed Res Int. .

Abstract

Aims: Lactate and lactate clearance were supposed to be associated with cardiac arrest outcomes, but studies obtained different results. Thus, we conducted this meta-analysis to investigate the association between lactate or lactate clearance and neurological outcomes and their usefulness for prediction of neurological outcomes.

Methods: We conducted a systematic search in PubMed, Web of science, EMBASE, Medline, and Google Scholar until May 1, 2018, for relevant studies. Studies reporting lactate, lactate clearance on admission, or other time points after admission associated with neurological outcomes were included in our analysis. Pooled effect date was shown as weighed mean difference (WMD) and 95% confidence interval (CI). To measure the usefulness of lactate on admission to predict neurological outcomes, we also pooled the data of diagnostic test.

Results: 23 studies involving 6720 cardiac arrest (CA) patients were included. Results from our analysis indicated that patients with good neurological outcomes tended to have a lower lactate level on admission (WMD: -2.66 mmol/L, 95%CI: -3.39 to -1.93) and 12h, 24h, and 48h after admission (P<0.001). Furthermore, the pooled AUC for lactate level on admission to predict neurological outcomes was 0.77 (95%CI: 0.73-0.80). However, a significant association between lactate clearance and neurological outcomes was only found in 24h but not 12h lactate clearance rate.

Conclusions: Lactate levels on admission and all time points up to 48h were associated with neurological outcomes after CA, whereas the association between lactate clearance and neurological outcomes was not so stable. Lactate was a more robust surrogate marker than lactate clearance to predict neurological outcomes after CA.

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Figures

Figure 1
Figure 1
Flow diagram of study selection process.
Figure 2
Figure 2
Summary weighed mean difference (WMD) and 95% confidence intervals for lactate on admission between good and poor neurological outcomes (mmol/L).
Figure 3
Figure 3
Summary weighed mean difference (WMD) and 95% confidence intervals for lactate at 12h (a), 24h (b), and 48h (c) between good and poor neurological outcomes (mmol/L).
Figure 4
Figure 4
Pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), receiver operating characteristic curves (SROC), and diagnostic OR of serum lactate on admission for differentiating neurological outcomes after cardiac arrest.
Figure 5
Figure 5
Summary weighed mean difference (WMD) and 95% confidence intervals for lactate clearance rate at 12h (a) and 24h (b) after admission between good and poor neurological outcomes.
See this image and copyright information in PMC

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