The Prognostic Role of Plasma Lactate in Patients Diagnosed with Pulmonary Embolism in the Emergency Department

Year 2023, , 217 - 222, 01.11.2023

Serap Biberoğlu , Furkan Küçükbezirci

https://doi.org/10.38175/phnx.1370483

Abstract

Objective: Pulmonary embolism (PE) is the third most common acute cardiovascular disease. This retrospective study was analyzed of the patients diagnosed with PE, between January 1, 2021 and July 1, 2023, in the emergency department (ED). Although the addition of venous lactate to the 2019 European Society of Cardiology (ESC) algorithm may improve risk classification, it is anticipated that our study will contribute to guiding early treatment decisions and mortality predictions in the ED with the combination of right ventricular dysfunction associated with high lactate levels.
Material and Methods: Demographic data, vital signs, presence of additional diseases, plasma lactate levels and outcomes of the patients were analyzed retrospectively. ‘Pulmonary Embolism Severity Index’ (PESI), right heart failure, and plasma lactate levels were statistically analyzed to predict 30-day mortality.
Results: Categorical parameters of 104 patients diagnosed with PE in the study; 52.9% (n=55) were women, 48.1% (n=50) were smokers, and 91.3% (n=95) had comorbidities. Right ventricular failure was detected in 19.2% (n=20) and the mortality was 24.96%. When comparing lactate levels according to the PESI classification, there was a statistically significant difference between Class I (1.3 mmol/L) – II (1.9 mmol/L), Class I (1.3 mmol/L) – IV ( 2.4 mmol/L), Class I (1.3 mmol/L) – Class V (1.9 mmol/L) and, Class III (1.6 mmol/L) - IV (2.4 mmol/L) (p<0.05).
Conclusion: The study found a correlation between high plasma lactate level and right ventricular dysfunction. In conclusion; It is thought that plasma lactate levels in the emergency department will contribute to guiding early treatment decisions, prognosis and mortality predictions in patients diagnosed with PE.

Keywords

Pulmonary embolism, Emergency department, PESI, Lactate, Prognosis

Ethical Statement

Çalışma İstanbul Üniversitesi-Cerrahpaşa, Cerrahpaşa Tıp Fakültesi Etik Kurulu tarafından 6/09/2023 tarih, 2023/129 karar no, 794455 sayı numarası ile onaylandı.

Supporting Institution

Yoktur

Acil Serviste Pulmoner Emboli Tanısı Alan Hastalarda Plazma Laktatının Prognostik Rolü

Abstract

Amaç: Pulmoner emboli (PE) en sık görülen üçüncü akut kardiyovasküler hastalıktır. Acil servisde 1 Ocak 2021 ile 1 Temmuz 2023 tarihleri arasında PE tanısı alan hastaların retrospektif analizi yapıldı. 2019 Avrupa Kardiyoloji Cemiyeti (ESC) algoritmasına venöz laktat eklenmesi risk sınıflandırmasını iyileştirebilmekle birlikte, çalışmamızda da yüksek laktat seviyesi ile ilişkili sağ ventrikül fonksiyon bozukluğu kombinasyonu ile acil serviste erken tedavi kararları ve mortalite tahminlerinde yol göstermede katkıda bulunması öngörülmektedir.
Gereç ve Yöntem: Retrospektif olarak, hastaların demografik verileri, vital bulguları, ek hastalıkların varlığı ve plazma laktat düzeyleri ile sonlanımları analiz edildi. 30 günlük mortaliteyi öngörmede ‘Pulmonary Embolism Severity Index’ (PESI), sağ kalp yetmezliği ve plazma laktat seviyeleri istatistiksel olarak analiz edildi.
Bulgular: Çalışmada PE tanısı alan 104 hastanın kategorik parametreleri; %52,9’u (n=55) kadın, %48,1’i (n=50) sigara kullanıyor ve %91,3’ünde (n=95) de ek hastalıkları var idi. %19,2’sinde (n=20) sağ ventrikül yetmezliği saptanmış olup, mortalitesi de %24,96 idi. Sağ ventrikül yetmezliği olan hastaların ortanca plazma laktat düzeyleri (2,25 mmol/L), sağ ventrikül yetmezliği gelişmeyenlere (1,7 mmol/L) kıyasla anlamlı yüksek idi (p=0,01). PESI sınıflamasına göre plazma laktat düzeylerinin karşılaştırılmasında Sınıf I (1,3 mmol/L) – II (1,9 mmol/L), Sınıf I (1,3 mmol/L) – IV ( 2,4 mmol/L), Sınıf I (1,3 mmol/L) – Sınıf V (1,9 mmol/L) ve Sınıf III (1,6 mmol/L) - IV (2,4 mmol/L) arasında istatistiksel olarak anlamlı fark mevcuttu (p<0,05).
Sonuç: Çalışmada yüksek laktat seviyesi ile sağ ventrikül fonksiyon bozukluğu arasında korelasyon bulunmuştur. Sonuç olarak; acil serviste plazma laktat düzeyleri PE tanısı alan hastalarda erken tedavi kararlarında, prognozda ve mortalite tahminlerinde yol göstermede katkıda bulunacağı düşünülmektedir.

Keywords

Acil servis, Pulmoner emboli, Laktat, Prognoz, PESI

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