Lactate and Lactate Clearance as Outcome Predictors in Brain‐Dead Potential Organs: A Secondary Cohort Analysis Embedded Within a Cluster‐Randomized Clinical Trial
Glauco Adrieno Westphal, Alexandre Biasi Cavalcanti, Caroline Cabral Robinson, Natalia Elis Giordani, Cassiano Teixeira, Adriane Isabel Rohden, Bruna Passos Gimenes, Cátia Moreira Guterres, Itiana Cardoso Madalena, Luiza Vitelo Andrighetto, Sabrina Souza da Silva, Daiana Barbosa da Silva, Daniel Sganzerla, Cristiano Augusto Franke, Fernando Augusto Bozza, Flávia Ribeiro Machado, Joel de Andrade, Luciano Cesar Pontes Azevedo, Silvana Schneider, Luciano Serpa Hammes, Regis Goulart Rosa, Rafael Barberena Moraes, Juliano Ramos, Alvaro Vigo, Renan Baiocco Pereira, Gabriela Soares Rech, Maicon FalavignaABSTRACT
Although lactate levels and lactate clearance are associated with outcomes in shock states, their prognostic value in brain‐dead potential organ donors remains unclear and is not mentioned in clinical guidelines as a perfusion marker to guide clinical intervention. We aimed to evaluate whether lactate levels and lactate clearance may predict losses of brain‐dead potential organ donors to cardiac arrest. This was a secondary analysis embedded within the cluster‐randomized DONORS trial. Participants were stratified according to baseline lactate level: <2 mmol/L and ≥2 mmol/L. Individuals with lactate measurements at enrollment and after 6 h were classified according to lactate clearance: <10% or ≥10%. The primary outcome was loss of potential donors to cardiac arrest prior to organ procurement. Among 1043 participants, those with baseline lactate ≥2 mmol/L were more likely to develop cardiac arrest (53/386 [13.7%] vs. 62/657 [9.4%]; p = 0.016) and less likely to become actual donors (151/386 [39.1%] vs. 308/657 [46.9%]; p = 0.022). In adjusted analyzes, baseline lactate ≥2.0 mmol/L was associated with increased risk of cardiac arrest (OR, 1.59; 95% CI, 1.09–2.33; p = 0.016). High lactate clearance was associated with more cardiac arrests (OR, 3.44; 95% CI, 1.61–7.14; p = 0.001). Elevated baseline lactate identifies brain‐dead potential donors at increased risk of cardiac arrest, whereas a lactate clearance <10% was associated with a higher risk.