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

	Entire study cohort N = 161	In-hospital mortality N = 32	Survival to discharge N = 129	p value
General Characteristics
Age (years)	68.61 ± 11.54	69.96 ± 13.58	68.34 ± 11.04	0.47
Sex (female), n (%)	89 (54.94%)	20 (62.50%)	69 (53.49%)	0.47
Malignancy, n (%)	37 (22.98%)	10 (31.25%)	27 (20.93%)	0.31
Clinical Parameters
Dyspnea, n (%)	146 (90.68%)	31 (96.88%)	115 (89.15%)	0.31
Chest pain, n (%)	45 (27.95%)	1 (3.13%)	44 (34.11%)	0.001
HR (bpm)	101.63 ± 19.60	106.54 ± 24.53	100.44 ± 18.14	0.12
SBP(mmHg)	134.98 ± 22.81	132.18 ± 23.67	135.67 ± 22.64	0.44
O2 Sat (%)	89.65 ± 8.74	87.77 ± 9.87	90.12 ±8.41	0.17
PESI score	105.62 ± 29.85	126.43 ± 35.69	100.46 ± 25.88	< 0.001
Laboratory Parameters
Troponin I (ng/mL)	1.17 [0.2 – 20.3]	0.40 [0.20 – 2.33]	0.29 [0.20 – 1.02]	0.23
NT-proBNP^*(pg/dL)	1830.5 [479 – 7288.5]	6143 [1664.5 – 9465]	1613 [387.5 – 6403.5]	0.02
Hemoglobin (g/dL)	13.18 ± 2.68	12.71 ± 2.38	13.31 ± 2.75	0.25
Creatinine (mg/dL)	1.10 ± 0.58	1.02 [0.81 – 1.38]	1.01 [0.80 – 1.19]	0.50
Lactate (mg/dL)	20.76 (12 – 22.52)	32.04 [13.48 – 41.37]	17.96 [11.62 – 21]	0.004
Central localization of thrombus, n (%)	104 (73.76%)	19 (76.00%)	85 (73.28%)	0.97
S1Q3T3, n (%)	59 (37.34%)	14 (23.73%)	45 (76.27%)	0.52
Right ventricular dysfunction^**, n (%)	36 (41.38%)	7 (58.33%)	29 (38.67%)	0.33
RH thrombus, n (%)	29 (20.42%)	9 (31.03%)	20 (17.70%)	0.18
TAPSE (mm)	17.96 ±4.39	16 ± 2.99	18.18 ± 4.55	0.24
DVT, n (%)	63 (43.45%)	11 (17.46%)	52 (82.54%)	0.77
Treatment
Thrombolysis, n (%)	18 (11.39%)	5 (15.63%)	13 (10.32%)	0.59
Inotropic therapy, n (%)	24 (15.19%)	15 (48.39%)	9 (7.09%)	< 0.001
Outcomes
In hospital mortality, n (%)	32 (19.88%)	N/A	N/A	N/A
Hospitalization period (days)	10.50 [7 – 52]	9.61 [1 – 51]	10.65 [8 – 52]	0.005

* Data available for 80 patients;

** Data available for 87 patients

HR – heart rate, SBP – systolic blood pressure, SBD – diastolic blood pressure, TAPSE – Tricuspid Annular Plane Systolic Excursion, DVT – deep vein thrombosis, RH – right heart, N/A – not applicable

Serum lactate – predictor of all-cause in-hospital mortality

Table 2

Predictors of elevated lactate levels > 38mg/dL

		p value
Demographics
Male sex	OR 1.01 (0.37 – 2.71)	0.98
Age	AUC 0.556 (0.415 – 0.697)	0.44
Clinical parameters
HR (bpm)	AUC 0.604 (0.445 – 0.754)	0.16
SBP (mmHg)	AUC 0.498 (0.336 – 0.660)	0.97
DBP (mmHg)	AUC 0.504 (0.455 – 0.754)	0.96
PESI score	AUC 0.674 (0.538 – 0.810)	0.016
SatO2 < 90%	OR 3.79 (1.13 – 12.75)	0.04
DVT	OR 1.58 (0.50 – 4.96)	0.61
Syncope	OR 0.72 (0.15 – 3.39)	0.95
Laboratory parameters
Troponin I	AUC 0.529 (0.382 – 0.676)	0.69
NT-proBNP^*	AUC 0.626 (0.447 – 0.805)	0.22
Hemoglobin	AUC 0.473 (0.311 – 0.635)	0.71
Creatinine	AUC 0.530 (0.398 – 0.663)	0.67
ECG
New RBBB	OR 1.29 (0.47 – 3.56)	0.81
ST elevation in precordial leads	OR 7.89 (1.89 – 32.79)	0.006
ST elevation in inferior leads	OR 2.97 (0.72 – 12.21)	0.26
Negative T waves in precordial leads	OR 1.11 (0.40 – 3.04)	0.83
Imaging parameters
RH thrombus	OR 3.42 (1.08 – 10.82)	0.04
RV dysfunction	OR 1.81 (0.55 – 5.92)	0.49
McConnel sign	OR 2.02 (0.37 – 10.89)	0.74
Central localization of thrombus	OR 2.28 (0.48 – 10.71)	0.45
Treatment
Positive inotropic treatment	OR 6.94 (2.35 – 20.56)	< 0.001
Thrombolysis	OR 0.39 (0.11 – 1.34)	0.25

* Data available for 80 patients

HR – heart rate, SBP – systolic blood pressure, DBP – diastolic blood pressure, RBBB – right bundle branch block, RV – right ventricle, TAPSE – Tricuspid Annular Plane Systolic Excursion, DVT – deep vein thrombosis, RH – right heart

Table 3

Multivariable analysis for in-hospital mortality

	HR (95%CI)	p value
Model 1
PESI score	1.03 (1.01 – 1.04)	0.001
Lactate level	1.05 (1.02 – 1.08)	0.003
Model 2
PESI score	1.03 (1.01 – 1.04)	0.001
Lactate level > 18 mg/dL	2.09 (0.89 – 4.88)	0.088
Model 3
PESI score	1.03 (1.01 – 1.04)	< 0.001
Lactate level > 38 mg/dL	7.49 (2.41 – 23.25)	< 0.001
Model 4
PESI score	1.03 (1.01 – 1.04)	< 0.001
RV dysfunction	1.73 (0.61 – 5.05)	0.302
Troponin I	1.03 (0.87 – 1.21)	0.176
Model 5
PESI score	1.03 (1.01 – 1.04)	0.002
RV dysfunction	3.14 (0.90 – 11.02)	0.07
Troponin I	1.05 (0.88 – 1.24)	0.609
Lactate level > 38 mg/dL	10.92 (3.04 – 39.29)	< 0.001

Table 4

Predictive performance of the derived predictive models for inhospital mortality

	AUC	p value
PESI score	0.725 (0.621 – 0.829)	< 0.001
Model 3	0.769 (0.666 – 0.872)	< 0.001
Model 4	0.736 (0.638 – 0.835)	< 0.001
Model 5	0.807 (0.711 – 0.902)	< 0.001

[i] Model 3: PESI score + lactate > 38 mg/dL

[ii] Model 4 (2019 ESC guidelines algorithm): PESI score + RV dysfunction + troponin I

[iii] Model 5: PESI score + RV dysfunction + troponin I + lactate > 38 mg/dL

Comparison of in-hospital mortality prediction models

References

Authors

Metrics

Articles in this issue

DOI: https://doi.org/10.2478/rjc-2022-0034 | Journal eISSN: 2734-6382 | Journal ISSN: 1220-658X

Journal RSS Feed

Language: English, Romanian

Page range: 182 - 188

Published on: Dec 31, 2022

Published by: Romanian Society of Cardiology

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

serum lactate,

pulmonary thromboembolism,

in-hospital mortality

Related subjects:

Pediatrics and juvenile medicine,

Paediatric cardiology,

Surgery,

Cardiac surgery

© 2022 Rodica Lucia Avram, Monica Mariana Băluță, Caterina Delcea, Anna Maria Andronescu, Elena Lechea, Gabriela Vladu, Alexandru Cristian Nechita, published by Romanian Society of Cardiology
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 32 (2022): Issue 4 (December 2022)

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

Figures & Tables

Figure 1

Table 1

Figure 2

Table 2

Table 3

Table 4

Figure 3

Paradigm

My account