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Serum Lactate, an Independent Prognostic Marker in Normotensive Patients with Acute Pulmonary Thromboembolism

Revista Romana de Cardiologie, ISSN: 2734-6382, Vol: 32, Issue: 4, Page: 182-188
2022
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Article Description

Objective: Serum lactate, a marker of tissue hypoxia, is an important prognostic factor in sepsis, trauma, and cardiogenic shock. Data on the direct correlation of serum lactate and in-hospital mortality in normotensive acute pulmonary thromboembolism (APE) patients, however, remains scarce. Material and methods: We analyzed normotensive APE patients admitted to our clinic from January 1, 2014, to December 31, 2021. Serum lactate was collected from arterial blood at admission. Results: The study sample included 161 patients with an average age of 68.61 ± 11.54 years. 54.94% were female. In-hospital mortality was 19.88%. In ROC analysis, serum lactate was a predictor of in-hospital mortality with an AUC of 0.662 (95%CI 0.584 - 0.735, p = 0.005). The cut-off level identified by the Youden index-associated criterion was > 38 mg/dL (34.38% sensitivity, 94.57% specificity). In multivariable analysis for in-hospital mortality alongside the biomarkers proposed by the 2019 ESC guidelines for severity assessment, lactate > 38 mg/dL was an independent predictor of mortality (OR 10.92, 95%CI 3.04 - 39.29, p < 0.001). The prediction model including PESI score, right ventricular dysfunction, troponin I, and lactate > 38 mg/dL had the best predictive performance for in-hospital mortality (AUC 0.807, p < 0.001). Conclusions: Elevated serum lactate is an independent predictor of all-cause in-hospital mortality of normotensive APE patients, with the optimal cut-off > 38 mg/dL. Adding the lactate level for mortality prediction outperformed the 2019 ESC guidelines algorithm for severity assessment of normotensive APE patients.

Bibliographic Details

Rodica Lucia Avram; Monica Mariana Baluta; Anna Maria Andronescu; Gabriela Vladu; Alexandru Cristian Nechita; Caterina Delcea; Elena Lechea

Walter de Gruyter GmbH

Medicine

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