Poster 055: Prognostic Value of Serial Lactate Measurements and Lactate Clearance in Adult Non-Septic Cardiogenic Shock: A Systematic Review and Meta-Analysis

Background: Mortality in cardiogenic shock remains high despite advances in therapy. Although serum lactate is routinely measured, the prognostic value of serial lactate clearance in non-septic cardiogenic shock is not well defined. We evaluated the association between early and sustained lactate clearance and short-term survival in adult patients with cardiogenic shock.

Methods: A systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines. PubMed, Web of Science, Scopus, and Google Scholar were searched for studies including adults (≥18 years) with non-septic cardiogenic shock reporting serial lactate measurements within the first 24 hours and short-term mortality outcomes. Lactate clearance was analyzed at 6–8 hours and 24 hours. Pooled mean differences (MD) were calculated using fixed- or random-effects models based on heterogeneity.

Outcome: Across the included studies, survivors consistently demonstrated significantly greater lactate clearance than non-survivors at all evaluated time points. At 6–8 hours, early lactate clearance was markedly higher among survivors, with a pooled mean difference of 22.46% (95% CI 18.60–26.32, p < 0.00001), reflecting strong inter-study consistency. This survival advantage further widened at 24 hours, with survivors achieving substantially greater lactate clearance (MD 28.44%, 95% CI 18.21–38.66, p < 0.00001). Despite variability across studies at the later time point, both the magnitude and direction of effect consistently favored survivors, underscoring the robust association between lactate clearance and short-term survival in non-septic cardiogenic shock.

Conclusion: Serial lactate clearance is a meaningful prognostic marker in non-septic cardiogenic shock. Early clearance within 6–8 hours is consistently associated with survival, while sustained clearance at 24 hours strengthens prognostic value despite inter-study variability. Larger observational studies and randomized trials are needed to validate findings and assess lactate-guided management strategies.