Short-term clinical outcome of normotensive patients with acute PE and high plasma lactate. Issue 4 (6th February 2015)

• Record Type: Journal Article
• Authors: Vanni, Simone; Jiménez, David; Nazerian, Peiman; Morello, Fulvio; Parisi, Michele; Daghini, Elena; Pratesi, Mauro; López, Raquel; Bedate, Pedro; Lobo, José Luis; Jara-Palomares, Luis; Portillo, Ana K; Grifoni, Stefano
• Is Part Of: Thorax. Volume 70:Issue 4(2015)
• Page Start: 333
• Page End: 338
• Publication Date: 2015-02-06
• Subjects: Pulmonary Embolism; Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thoraxjnl-2014-206300
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Background: Strategies for identifying normotensive patients with acute symptomatic PE at high risk of PE-related complications remain to be defined. Methods: This prospective cohort study aimed to determine the role of plasma lactate levels in the risk assessment of normotensive patients with acute PE. Outcomes assessed over the 7 days after the diagnosis of PE included PE-related mortality and haemodynamic collapse, defined as need for cardiopulmonary resuscitation, systolic blood pressure <90 mm Hg for at least 15 min, need for catecholamine administration, or need for mechanical ventilation. Results: Between December 2012 and January 2014, the study enrolled 496 normotensive outpatients with acute symptomatic PE. PE-related complications occurred in 20 (4.0%; 95% CI 2.5% to 6.2%) of the 496 patients. These patients had higher baseline lactate levels (median 2.66 mmol/L; IQR 1.56–5.96 mmol/L) than patients without complications (1.20 mmol/L; IQR 1.20–2.00 mmol/L) (p<0.001). Overall, 135 patients (27.2%) had plasma lactate ≥2 mmol/L. Fourteen (10.4%) of them had PE-related complications versus 6 of 361 patients with low lactate (negative predictive value 98.3%; p<0.001). Patients with elevated plasma lactate had an increased rate of PE-related complications (adjusted OR 5.3; 95% CI 1.9 to 14.4; p=0.001) compared with those with low lactate. The combination of elevated plasma lactate with markers of right ventricular dysfunction (by echocardiogram) and myocardial injury (by cardiac troponin) was a particularly useful prognostic indicator (positive predictive value 17.9%; 95% CI 6.1% to 36.9%). Conclusions: Plasma lactate represents a powerful predictor of short-term PE-related complications and may provide guidance for decision-making in PE care.