title: Short-term clinical outcome of normotensive patients with acute PE and high plasma lactate.
abstract: BACKGROUND
  Strategies for identifying normotensive patients with acute symptomatic PE at high risk of PE-related complications remain to be defined.
  
  
  METHODS
  This prospective cohort study aimed to determine the role of plasma lactate levels in the risk assessment of normotensive patients with acute PE. Outcomes assessed over the 7 days after the diagnosis of PE included PE-related mortality and haemodynamic collapse, defined as need for cardiopulmonary resuscitation, systolic blood pressure <90 mm Hg for at least 15 min, need for catecholamine administration, or need for mechanical ventilation.
  
  
  RESULTS
  Between December 2012 and January 2014, the study enrolled 496 normotensive outpatients with acute symptomatic PE. PE-related complications occurred in 20 (4.0%; 95% CI 2.5% to 6.2%) of the 496 patients. These patients had higher baseline lactate levels (median 2.66 mmol/L; IQR 1.56-5.96 mmol/L) than patients without complications (1.20 mmol/L; IQR 1.20-2.00 mmol/L) (p<0.001). Overall, 135 patients (27.2%) had plasma lactate ≥2 mmol/L. Fourteen (10.4%) of them had PE-related complications versus 6 of 361 patients with low lactate (negative predictive value 98.3%; p<0.001). Patients with elevated plasma lactate had an increased rate of PE-related complications (adjusted OR 5.3; 95% CI 1.9 to 14.4; p=0.001) compared with those with low lactate. The combination of elevated plasma lactate with markers of right ventricular dysfunction (by echocardiogram) and myocardial injury (by cardiac troponin) was a particularly useful prognostic indicator (positive predictive value 17.9%; 95% CI 6.1% to 36.9%).
  
  
  CONCLUSIONS
  Plasma lactate represents a powerful predictor of short-term PE-related complications and may provide guidance for decision-making in PE care.
authors: Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
authors: Simone
authors: S
authors: Vanni
authors: Respiratory Department, Ramón y Cajal Hospital, IRYCIS, Alcalá de Henares University, Madrid, Spain.
authors: David
authors: D
authors: Jiménez
authors: Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
authors: Peiman
authors: P
authors: Nazerian
authors: Emergency Department, A.O.U. Città della Salute e della Scienza di Torino, Ospedale Molinette, Torino, Italy.
authors: Fulvio
authors: F
authors: Morello
authors: Emergency Department, Ospedale M. Bufalini, Cesena, Italy.
authors: Michele
authors: M
authors: Parisi
authors: Emergency Department, Presidio Ospedaliero Livorno, Italy.
authors: Elena
authors: E
authors: Daghini
authors: Emergency Department, Presidio Ospedaliero Livorno, Italy.
authors: Mauro
authors: M
authors: Pratesi
authors: Respiratory Department, La Fe Hospital, Valencia, Spain.
authors: Raquel
authors: R
authors: López
authors: Respiratory Department, Central University Hospital of Asturias, Oviedo, Spain.
authors: Pedro
authors: P
authors: Bedate
authors: Respiratory Department, Txagorritxu Hospital, Vitoria, Spain.
authors: José Luis
authors: JL
authors: Lobo
authors: Respiratory Department, Virgen del Rocio Hospital, Sevilla, Spain.
authors: Luis
authors: L
authors: Jara-Palomares
authors: Respiratory Department, Ramón y Cajal Hospital, IRYCIS, Alcalá de Henares University, Madrid, Spain.
authors: Ana K
authors: AK
authors: Portillo
authors: Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
authors: Stefano
authors: S
authors: Grifoni
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D018570:Risk Assessment / Q000379:methods; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D019344:Lactic Acid
keywords: Pulmonary Embolism