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Cohort studyJournal of clinical epidemiology · 2026

Missing Lactate Values in Critical Care Registries: A Multiple Imputation Framework for Cardiogenic Shock Research.

Robert Thiesmeier, Jeong-Gun Park, Siddharth M Patel … Andrea Bellavia

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CardiologyCohort study

Imputing missing lactate values significantly reclassifies patient risk in cardiogenic shock.

Missing Lactate Values in Critical Care Registries: A Multiple Imputation Framework for Cardiogenic Shock Research.

Robert Thiesmeier et al. · Journal of clinical epidemiology · 2026

Purpose

Lactate is a critical prognostic biomarker in observational studies of cardiac intensive care.

Methods

To assess the practical implications of this imputation procedure, we evaluated risk reclassification when using imputed lactate for computing the IABP-SHOCK II risk score.

n = 17,993 admissions

ranging from -0.13% to 2.70%

Results

percentage of patients whose risk of death changed, often to higher risk

n = 17,993 admissions

More results

Missingness was associated with patient severity, confirming the data were not missing completely at random.

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Conclusion · 1 of 3

Missing lactate measurements are a source of selection and measurement bias in critical care registries. A structured imputation framework mitigates bias and improves the reliability of real-world evidence in cardiovascular epidemiology.

Conclusion · 2 of 3

Lactate is a blood marker that helps clinicians assess how sick a patient is and is commonly used in risk prediction tools for patients with cardiogenic shock.

Conclusion · 3 of 3

However, lactate measurements are often missing in clinical registries because testing practices vary across hospitals and patient groups.

Post

Missing Lactate Values in Critical Care Registries: A Multiple Imputation Framework for Cardiogenic Shock Research.

Imputing missing lactate values significantly reclassifies patient risk in cardiogenic shock.

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