Prognostic value of lactates in relation to gas analysis and acid-base status in patients with pulmonary embolism

Abstract

AimTo assess the prognostic value of lactate level for mortality in patients with pulmonary embolism (PE) and Pulmonary Embolism Severity Index (PESI) I-III and its independence of gas-analysis parameters and acid-base status.MethodsThis prospective observational study was conducted at the University Clinical Hospital Mostar from 2013 to 2017. On the first day after PE diagnosis, 1.5 mL of arterial blood was collected from 103 patients with PE. Partial pressure of oxygen in arterial blood, partial pressure of carbon dioxide in arterial blood, blood pH value, concentration of bicarbonates in arterial blood (HCO3-), base deficit, and oxygen saturation were analyzed. Lactate levels were assessed using blood samples taken from the cubital vein. Logistic regression analysis was used to assess the predictive value of gas-analysis variables, lactate level, PESI score, age, and sex for in-hospital death due to PE.ResultsThe mortality in the group of PE patients was 19.1% (18 of 103 patients). Lactate level was an independent predictor of mortality (P = 0.002, odds ratio 0.06). HCO3- was also found to be a significant predictor (P = 0.022, odds ratio 2.4). Lactates were independent of other variables. Other gas-analysis parameters were not significant predictors of mortality.ConclusionIn PE patients at low-intermediate risk of mortality (PESI I-III), lactate level was associated with a short-term mortality, independently of other gas-analytic parameters.Oxford Centre for Evidence-based Medicine level of evidence: 2.

Acil Serviste Pulmoner Emboli Tanısı Alan Hastalarda Laktat ve Laktat Klerensinin Mortalite Üzerine Etkisinin Retrospektif Değerlendirilmesi

“…Logistic regression analysis of lactate values affecting PE related mortality in patients diagnosed with pulmonary embolism in the ED Galić K et al reported in their study that PE patients with a plasma lactate value >3 mmol/L had a very high mortality rate(9). In our study, the mortality risk in the group having lactate values ≥3 mmol/L was higher than the other two groups and the normotensive patient group.…”

Characteristics and 6-Month Mortality of Medical Oncology Patients With Incidental and Symptomatic Pulmonary Embolism: A Single-Institutional Retrospective Longitudinal Analysis

“…Previous study demonstrated that lactic acid has been linked to a greater risk of short-term mortality in patients with PE with a low-intermediate risk, independent of other gas-analytic parameters. 21 However, cancer patients were excluded from that study. The present study is the first, to our knowledge, to mention elevated lactic acid levels as a possible indicator of asymptomatic PE among cancer patients.…”

Characteristics and outcomes of cancer patients who develop pulmonary embolism: A cross‑sectional study

“…Lactic acid has been reported to be associated with a high risk of mortality and adverse outcomes among patients with PE ( 23 ), and an increased in-hospital mortality in patients with acute PE ( 24 ). Furthermore, lactic acid has been linked to a greater risk of short-term mortality in patients with PE with a low-intermediate risk, independent of other gas-analytic parameters ( 25 ). In a recent study, Ząbczyk et al ( 26 ) reported that increased lactic acid levels were associated with increased neutrophil extracellular trap (NET) formation and prothrombotic fibrin clot features, with impaired plasma fibrinolytic potential in patients with acute PE.…”