title: High plasma lactate levels are associated with increased risk of in-hospital mortality in patients with pulmonary embolism.
abstract: OBJECTIVE
  The objective was to investigate the prognostic value of plasma lactate in patients with acute pulmonary embolism (PE).
  
  
  METHODS
  This was a retrospective study at the emergency department (ED) of a third-level teaching hospital. The authors considered consecutive patients with a diagnosis of PE established by lung scan or spiral computed tomography (CT) and confirmed by pulmonary angiography if necessary. Only patients for whom plasma lactate levels had been tested within 6 hours from presentation to the ED were included. Primary outcome was in-hospital death due to any cause; secondary outcome was mortality related to PE.
  
  
  RESULTS
  From September 1997 to June 2006, a total of 384 patients were diagnosed with PE in the ED. Of these patients, 287 had registered plasma lactate levels and were included in this analysis. Included patients had a mean age of 70 (SD ± 15 years, range = 18 to 100 years), 163 (57%) were female, 26 (9%) showed systolic blood pressure lower than 100 mm Hg at presentation, and 160 (56%) had echocardiographic evidence of right ventricular dysfunction (RVD). Twenty patients died during their hospital stay (7%). Plasma lactate levels ≥ 2 mmol/L were associated with in-hospital mortality from all causes (odds ratio [OR] = 4.60, 95% confidence interval [CI] = 1.57 to 13.53) and with PE-related mortality (OR = 4.94, 95% CI = 1.38 to 17.63), independent of hypotension or RVD at presentation.
  
  
  CONCLUSIONS
  High plasma lactate was associated with increased in-hospital mortality in this sample of patients with acute PE.
authors.affiliation: Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. simonevanni@alice.it
authors.forename: Simone
authors.initials: S
authors.lastname: Vanni
authors.forename: Filippo
authors.initials: F
authors.lastname: Socci
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pepe
authors.forename: Peiman
authors.initials: P
authors.lastname: Nazerian
authors.forename: Gabriele
authors.initials: G
authors.lastname: Viviani
authors.forename: Michele
authors.initials: M
authors.lastname: Baioni
authors.forename: Alberto
authors.initials: A
authors.lastname: Conti
authors.forename: Stefano
authors.initials: S
authors.lastname: Grifoni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001784:Blood Gas Analysis; D002423:Cause of Death; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007773:Lactates / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D007773:Lactates