Acil Serviste Pulmoner Emboli Tanısı Alan Hastalarda Laktat ve Laktat Klerensinin Mortalite Üzerine Etkisinin Retrospektif Değerlendirilmesi
Abstract
Amaç: Pulmoner emboli, kardiyovasküler hastalığa bağlı ölümlerin üçüncü önde gelen nedenidir. Pulmoner emboli de şok veya hipotansiyon varlığı ana prognostik klinik belirteç olmaya devam etmektedir ve bugüne kadar agresif tedavi ihtiyacını gösteren tek faktördür. Pulmoner embolili hastaların çoğu normotansiftir. Pulmoner emboli hastalarını daha iyi sınıflandırmak için prognostik göstergelere ihtiyaç vardır. Bu çalışmada, acil serviste pulmoner emboli tanısı konulan hastalarda laktat düzeyinin hastane mortalitesini öngörmedeki etkisi ve laktat düzeyi yüksek (laktat ≥2 mmol/L) hastalarda laktat klirensinin mortaliteye etkisi araştırıldı.
Gereç ve Yöntemler: Bu çalışma retrospektif bir çalışma olarak tasarlanmıştır. 1 Ocak 2018-31 Aralık 2019 tarihleri arasında üniversite hastanesi acilinde bilgisayarlı tomografi anjiyografisi ile pulmoner emboli tanısı alan erişkin (>18 yaş) hastalar analiz edilmiştir.
Bulgular: Acil serviste toplam 367 hastaya pulmoner emboli tanısı kondu. Hastaların hastane içi mortalite oranı %29,8, pulmoner emboli ile ilişkili mortalite oranı ise %12,4 idi. Laktat klirensi mortalite riskini öngörmede anlamlı değildi. Pulmoner emboli hastalarında mortaliteyi etkileyen risk faktörleri arasında yapılan lojistik regresyon analizinde laktat ≥3 mmol/L ve normotansif + laktat ≥3 mmol/L hastane içi mortaliteyi öngörmede anlamlı bulundu.
Sonuç: Acil serviste laktat düzeyi akut pulmoner emboli hastalarında mortaliteyi belirlemede etkili bir tarama yöntemi olabilir.
Keywords
References
- Pulido T, Aranda A, Zevallos MA, et al. Pulmonary embolism as a cause of death in patients with heart disease: an autopsy study. Chest. 2006;129:1282-1287.
- Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology. Eur Heart J. 2008;29:2276-2315.
- Grifoni S, Olivotto I, Cecchini P, et al. Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction. Circulation. 2000;101:2817-2822.
- Becattini C, Vedovati MC, Agnelli G. Prognostic value of troponins in acute pulmonary embolism: a meta-analysis. Circulation. 2007; 116:427-433.
- Binder L, Pieske B, Olschewski M, et al. N-terminal pro-brain natriuretic peptide or troponin testing followed by echocardiography for risk stratification of acute pulmonary embolism. Circulation. 2005;112:1573-1579.
- Vanni S, Viviani G, Baioni M, Pepe G, Nazerian P, Socci F, et al. Prognostic value of plasma lactate levels among patients with acute pulmonary embolism: the thrombo-embolism lactate outcome study. Ann Emerg Med 2013;61:330–8. http://www.ncbi.nlm.nih.gov/pubmed/23306454.
- Vanni S, Jiménez D, Nazerian P, Morello F, Parisi M, Daghini E, et al. Short-term clinical outcome of normotensive patients with acute PE and high plasma lactate. Thorax 2015;70:333–8. http://www.ncbi.nlm.nih.gov/pubmed/25661114.
- Vanni S, Nazerian P, Bova C, Bondi E, Morello F, Pepe G, et al. Comparison of clinical scores for identification of patients with pulmonary embolism at intermediate-high risk of adverse clinical outcome: the prognostic role of plasma lactate. Intern Emerg Med 2017;12:657–65. http://www.ncbi.nlm.nih.gov/pubmed/27350628.
- Galić K, Pravdić D, Prskalo Z, Kukulj S, Starčević B, Vukojević M. Prognostic value of lactates in relation to gas analysis and acid–base status in patients with pulmonary embolism. Croat Med J 2018;59:149–55. doi: 10.3325/cmj.2018.59.149. http://www.ncbi.nlm.nih.gov/pubmed/30203628. PMC6139423.
- Bach AG, Taute BM, Baasai N, Wienke A, Meyer HJ, Schramm D, Surov A. 30-day mortality in acute pulmonary embolism: prognostic value of clinical scores and anamnestic features. PLOS ONE 2016;11:e0148728. doi: 10.1371/journal.pone.0148728. http://www.ncbi.nlm.nih.gov/pubmed/26866472. PMC4750907.
- Jiménez D, Aujesky D, Moores L, Gómez V, Lobo JL, Uresandi F, et al. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med 2010;170:1383–9.
- Righini M, Roy PM, Meyer G, Verschuren F, Aujesky D, Le Gal G. The Simplified Pulmonary Embolism Severity Index (PESI): validation of a clinical prognostic model for pulmonary embolism. J Thromb Haemost 2011;9:2115–7.
- Sam A, Sánchez D, Gómez V, Wagner C, Kopecna D, Zamarro C, et al. The shock index and the simplified PESI for identification of low-risk patients with acute pulmonary embolism. Eur Respir J 2011;37:762–6.
- Harjola VP, Mebazaa A, Čelutkienė J, Bettex D, Bueno H, Chioncel O, et al. Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology. Eur J Heart Fail 2016;18:226–41.
- Lankeit M, Friesen D, Aschoff J, Dellas C, Hasenfuss G, Katus H, et al. Highly sensitive troponin T assay in normotensive patients with acute pulmonary embolism. Eur Heart J 2010;31:1836–44.
- Odom SR, Howell MD, Silva GS, Nielsen VM, Gupta A, Shapiro NI, et al. Lactate clearance as a predictor of mortality in trauma patients. J Trauma Acute Care Surg. 2013;74:999–1004. doi: 10.1097/TA.0b013e3182858a3e. Erratum in: J Trauma Acute Care Surg. PMID: 23511137 2014 Mar;76:902.
- Ryoo SM, Lee J, Lee YS, Lee JH, Lim KS, Huh JW, et al. Lactate level versus lactate clearance for predicting mortality in patients with septic shock defined by Sepsis-3. Crit Care Med 2018;46:e489–95. doi: 10.1097/CCM.0000000000003030. http://www.ncbi.nlm.nih.gov/pubmed/29432347.
The Effect of Lactate and Lactate Clearance on Mortality in Patients with Acute Pulmonary Embolism in Emergency Department
Abstract
Aim: Pulmonary embolism (PE) is the third leading cause of death due to cardiovascular disease. The presence of shock or hypotension remains the main prognostic clinical marker and to date, it is the only factor that indicates the need for aggressive treatment. Most patients with pulmonary embolism are normotensive. Prognostic indicators are needed to better classify patients with pulmonary embolism. This study aimed to investigate the effect of lactate level on predicting hospital mortality in patients diagnosed with pulmonary embolism in the emergency department, and the effect of lactate clearance on mortality in patients with high lactate levels (lactate ≥2 mmol/L).
Material and Methods: This study was designed as a retrospective study. Adult patients (>18-years old) who were diagnosed with PE by computed tomography angiography of the thorax in the university hospital emergency between January 1, 2018, and December 31, 2019, were analyzed.
Results: A total of 367 patients were diagnosed with pulmonary embolism in the emergency department. In-hospital mortality rate of the patients was 29.8% and the pulmonary embolism-related mortality rate was 12.4%. Lactate clearance was not significant in predicting mortality risk. In the logistic regression analysis performed among the risk factors affecting mortality in patients with pulmonary embolism, lactate ≥3 mmol/L and normotensive + lactate ≥3 mmol/L were significant in predicting in-hospital mortality.
Conclusion: The lactate level in the emergency department could be an effective screening method for identifying mortality in acute pulmonary embolism patients.
References
- Pulido T, Aranda A, Zevallos MA, et al. Pulmonary embolism as a cause of death in patients with heart disease: an autopsy study. Chest. 2006;129:1282-1287.
- Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology. Eur Heart J. 2008;29:2276-2315.
- Grifoni S, Olivotto I, Cecchini P, et al. Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction. Circulation. 2000;101:2817-2822.
- Becattini C, Vedovati MC, Agnelli G. Prognostic value of troponins in acute pulmonary embolism: a meta-analysis. Circulation. 2007; 116:427-433.
- Binder L, Pieske B, Olschewski M, et al. N-terminal pro-brain natriuretic peptide or troponin testing followed by echocardiography for risk stratification of acute pulmonary embolism. Circulation. 2005;112:1573-1579.
- Vanni S, Viviani G, Baioni M, Pepe G, Nazerian P, Socci F, et al. Prognostic value of plasma lactate levels among patients with acute pulmonary embolism: the thrombo-embolism lactate outcome study. Ann Emerg Med 2013;61:330–8. http://www.ncbi.nlm.nih.gov/pubmed/23306454.
- Vanni S, Jiménez D, Nazerian P, Morello F, Parisi M, Daghini E, et al. Short-term clinical outcome of normotensive patients with acute PE and high plasma lactate. Thorax 2015;70:333–8. http://www.ncbi.nlm.nih.gov/pubmed/25661114.
- Vanni S, Nazerian P, Bova C, Bondi E, Morello F, Pepe G, et al. Comparison of clinical scores for identification of patients with pulmonary embolism at intermediate-high risk of adverse clinical outcome: the prognostic role of plasma lactate. Intern Emerg Med 2017;12:657–65. http://www.ncbi.nlm.nih.gov/pubmed/27350628.
- Galić K, Pravdić D, Prskalo Z, Kukulj S, Starčević B, Vukojević M. Prognostic value of lactates in relation to gas analysis and acid–base status in patients with pulmonary embolism. Croat Med J 2018;59:149–55. doi: 10.3325/cmj.2018.59.149. http://www.ncbi.nlm.nih.gov/pubmed/30203628. PMC6139423.
- Bach AG, Taute BM, Baasai N, Wienke A, Meyer HJ, Schramm D, Surov A. 30-day mortality in acute pulmonary embolism: prognostic value of clinical scores and anamnestic features. PLOS ONE 2016;11:e0148728. doi: 10.1371/journal.pone.0148728. http://www.ncbi.nlm.nih.gov/pubmed/26866472. PMC4750907.
- Jiménez D, Aujesky D, Moores L, Gómez V, Lobo JL, Uresandi F, et al. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med 2010;170:1383–9.
- Righini M, Roy PM, Meyer G, Verschuren F, Aujesky D, Le Gal G. The Simplified Pulmonary Embolism Severity Index (PESI): validation of a clinical prognostic model for pulmonary embolism. J Thromb Haemost 2011;9:2115–7.
- Sam A, Sánchez D, Gómez V, Wagner C, Kopecna D, Zamarro C, et al. The shock index and the simplified PESI for identification of low-risk patients with acute pulmonary embolism. Eur Respir J 2011;37:762–6.
- Harjola VP, Mebazaa A, Čelutkienė J, Bettex D, Bueno H, Chioncel O, et al. Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology. Eur J Heart Fail 2016;18:226–41.
- Lankeit M, Friesen D, Aschoff J, Dellas C, Hasenfuss G, Katus H, et al. Highly sensitive troponin T assay in normotensive patients with acute pulmonary embolism. Eur Heart J 2010;31:1836–44.
- Odom SR, Howell MD, Silva GS, Nielsen VM, Gupta A, Shapiro NI, et al. Lactate clearance as a predictor of mortality in trauma patients. J Trauma Acute Care Surg. 2013;74:999–1004. doi: 10.1097/TA.0b013e3182858a3e. Erratum in: J Trauma Acute Care Surg. PMID: 23511137 2014 Mar;76:902.
- Ryoo SM, Lee J, Lee YS, Lee JH, Lim KS, Huh JW, et al. Lactate level versus lactate clearance for predicting mortality in patients with septic shock defined by Sepsis-3. Crit Care Med 2018;46:e489–95. doi: 10.1097/CCM.0000000000003030. http://www.ncbi.nlm.nih.gov/pubmed/29432347.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Original Articles |
| Authors | |
| Publication Date | June 30, 2022 |
| Published in Issue | Year 2022 Volume: 5 Issue: 2 |
