Short-term clinical outcome of normotensive patients with acute PE and high plasma lactate

Thorax. 2015 Apr;70(4):333-8. doi: 10.1136/thoraxjnl-2014-206300. Epub 2015 Feb 6.

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.

Keywords: Pulmonary Embolism.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Blood Pressure / physiology
  • Female
  • Humans
  • Lactic Acid / blood*
  • Male
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Pulmonary Embolism / blood
  • Pulmonary Embolism / diagnosis*
  • Pulmonary Embolism / physiopathology
  • Pulmonary Embolism / therapy
  • Risk Assessment / methods
  • Treatment Outcome

Substances

  • Biomarkers
  • Lactic Acid