Venous lactate improves the prediction of in-hospital adverse outcomes in normotensive pulmonary embolism

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Ebner , M , Pagel , C F , Sentler , C , Harjola , V-P , Bueno , H , Lerchbaumer , M H , Stangl , K , Pieske , B , Hasenfuss , G , Konstantinides , S & Lankeit , M 2021 , ' Venous lactate improves the prediction of in-hospital adverse outcomes in normotensive pulmonary embolism ' , European Journal of Internal Medicine , vol. 86 , pp. 25-31 . https://doi.org/10.1016/j.ejim.2021.01.021

Title: Venous lactate improves the prediction of in-hospital adverse outcomes in normotensive pulmonary embolism
Author: Ebner, Matthias; Pagel, Charlotta F.; Sentler, Carmen; Harjola, Veli-Pekka; Bueno, Hector; Lerchbaumer, Markus H.; Stangl, Karl; Pieske, Burkert; Hasenfuss, Gerd; Konstantinides, Stavros; Lankeit, Mareike
Contributor organization: HUS Emergency Medicine and Services
University of Helsinki
Helsinki University Hospital Area
Date: 2021-04
Language: eng
Number of pages: 7
Belongs to series: European Journal of Internal Medicine
ISSN: 0953-6205
DOI: https://doi.org/10.1016/j.ejim.2021.01.021
URI: http://hdl.handle.net/10138/331758
Abstract: Background: Arterial lactate is an established risk marker in patients with pulmonary embolism (PE). However, its clinical applicability is limited by the need of an arterial puncture. In contrast, venous lactate can easily be measured from blood samples obtained via routine peripheral venepuncture. Methods: We investigated the prognostic value of venous lactate with regard to in-hospital adverse outcomes and mortality in 419 consecutive PE patients enrolled in a single-center registry between 09/2008 and 09/2017. Results: An optimised venous lactate cut-off value of 3.3 mmol/l predicted both, in-hospital adverse outcome (OR 11.0 [95% CI 4.6?26.3]) and all-cause mortality (OR 3.8 [95%CI 1.3?11.3]). The established cut-off value for arterial lactate (2.0 mmol/l) and the upper limit of normal for venous lactate (2.3 mmol/l) had lower prognostic value for adverse outcomes (OR 3.6 [95% CI 1.5?8.7] and 5.7 [95% CI 2.4?13.6], respectively) and did not predict mortality. If added to the 2019 European Society of Cardiology (ESC) algorithm, venous lactate Conclusion: Venous lactate above the upper limit of normal was associated with increased risk for adverse outcomes and an optimised cut-off value of 3.3 mmol/l predicted adverse outcome and mortality. Adding venous lactate to the 2019 ESC algorithm may improve risk stratification. Importantly, the established cut-off value for arterial lactate has limited specificity in venous samples and should not be used.
Subject: Pulmonary embolism
Venous lactate
Risk stratification
Prognosis
Biomarker
EUROPEAN-SOCIETY
TASK-FORCE
MANAGEMENT
THROMBOEMBOLISM
GUIDELINES
DIAGNOSIS
ARTERIAL
RISK
3121 General medicine, internal medicine and other clinical medicine
Peer reviewed: Yes
Rights: cc_by_nc_nd
Usage restriction: openAccess
Self-archived version: publishedVersion


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