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

Rodica Lucia Avram
Rodica Lucia Avram
, 
Monica Mariana Băluță
Monica Mariana Băluță
, 
Caterina Delcea
Caterina Delcea
, 
Anna Maria Andronescu
Anna Maria Andronescu
, 
Elena Lechea
Elena Lechea
, 
Gabriela Vladu
Gabriela Vladu
 und 
Alexandru Cristian Nechita
Alexandru Cristian Nechita
   | 31. Dez. 2022
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Article Category: Original Article
Online veröffentlicht: 31. Dez. 2022
Seitenbereich: 182 - 188
DOI: https://doi.org/10.2478/rjc-2022-0034
Schlüsselwörter
© 2022 Rodica Lucia Avram et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

PRISMA consort flow diagram of the study
PRISMA consort flow diagram of the study

Figure 2

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

Figure 3

Comparison of in-hospital mortality prediction models
Comparison of in-hospital mortality prediction models

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

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

Patients’ characteristics

Entire study cohortN = 161 In-hospital mortalityN = 32 Survival to dischargeN = 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

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
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