Lactate level and lactate clearance for acute kidney injury prediction among patients admitted with ST-segment elevation myocardial infarction: A retrospective cohort study
Xi Kathy Zhou, Yanlei He, Long Hu, Qianli Zhu, Qingcheng Lin, Xia Hong, Weijian Huang, Peiren Shan, Dongjie Liang
Abstract
Background Hyperlactatemia is a prognostic marker among patients with ST-segment elevation acute myocardial infarction (STEMI). However, the predictive value of lactate and the dynamic change associated with acute kidney injury (AKI) among patients with STEMI, remain poorly understood. We aimed to compare single lactate values at admission (Lac adm ) and 12 h after admission (Lac 12h ) with lactate clearance (LC) 12 h after admission for AKI prediction in patients with STEMI. Methods A total of 1,784 patients with STEMI were included. The study endpoint was AKI occurrence during hospitalization. The predictive value of lactate levels measured at admission and 12 h after admission and LC for AKI prediction was determined using multivariate logistic regression analyses and compared with receiver operator characteristic (ROC) curve analysis. Results Overall, AKI was observed in 353 (19.8%) patients. In multivariate logistic regression analyses, Lac adm ≥ 4.3 mmol/L (OR: 1.53; 95% CI: 1.01–2.30), Lac 12h ≥ 2.1 mmol/L (OR: 1.81; 95% CI: 1.36–2.42), and LC ≥ −7.5% (OR: 0.40; 95% CI: 0.30–0.53) were the independent predictive factors for AKI after adjusting for confounders. ROC curve analysis results revealed that Lac 12h (0.639; 95% CI: 0.616–0.661) exhibited a significantly higher area under the curve (AUC) than those of Lac adm (0.551; 95% CI: 0.527–0.574) and LC (0.593; 95% CI: 0.570–0.616) in the prediction of AKI. LC ( △ AUC = 0.037, p < 0.001) and Lac 12h ( △ AUC = 0.017, p = 0.029) enhanced the discrimination capacity of Mehran Risk Score (MRS) for AKI among patients undergoing emergency coronary angiography. Conclusion Lac 12h is more effective for AKI prediction among patients with STEMI than Lac adm and LC. Furthermore, Lac 12h and LC enhance the prediction capacity of MRS for AKI among patients after emergency coronary angiography.