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ADMISSION LACTATE AND OUTCOME IN INTERMEDIATE RISK (SUBMASSIVE) PULMONARY EMBOLISM

      TOPIC: Pulmonary Vascular Disease
      TYPE: Original Investigations
      PURPOSE: Intermediate-Risk (Submassive) Pulmonary Embolism (PE), defined by the absence of hypotension and presence of right ventricle dysfunction and /or cardiac biomarkers represent 1/5th of all PEs; 5-6.5% of these decompensate and progress to high-risk (massive) PE, with a reported mortality rate of 2.9%. Limited information exists on factors that might predict outcomes in Intermediate-risk PE. This study aims to determine the relationship between admission serum lactate (S.lactate) and outcome in Intermediate-risk PE.
      METHODS: Records of 54 patients hospitalized in our institution with intermediate-risk PE were reviewed. Age, gender, treatment interventions, and admission s.lactate were noted. Outcomes studied included requirement of O2, noninvasive (NIMV) and invasive mechanical ventilation (InvMV); occurrence of hemodynamic decompensation, in-hospital mortality, ICU length of stay (LOS). Pearson's correlation analysis was performed to assess the relation of s.lactate to studied outcomes. An independent t-test was performed to evaluate whether s.lactate differed in patients with different outcomes. p ≤ 0.05 was deemed statistically significant.
      RESULTS: Mean age was 66.5± 17 years; 51% were males. Fifty percent required supplemental O2 (FIO2: 34-100%); 3% required InvMV; 3% NIMV; 33% were treated with catheter-directed therapies (CDT); 3 patients (5%) had a cardiac arrest of whom 2 expired (3%). Pearson’s correlation analysis indicated a significant correlation between admission s.lactate and hemodynamic decompensation (r=0.808, p<0.001); in-hospital mortality (r=-0.543, p=0.004), need for NIMV (r=0.66, p<0.001); need for InvMV (r=0.808, p<0.001), need for CDT (r=0.436, p=0.03) and ICU LOS (r=0.642, p=0.002). Admission s.lactate in patients with studied outcomes are shown in table below.
      CONCLUSIONS: Admission S.lactate in Intermediate-risk PE indicates risk for hemodynamic decompensation, death, respiratory failure and should be routinely performed in these cases.
      CLINICAL IMPLICATIONS: S.lactate should be routinely obtained in Intermediate-Risk (Submassive) Pulmonary Embolism (PE) to predict hemodynamic decompensation, death, and respiratory failure outcomes.
      DISCLOSURES: No relevant relationships by Soontharee Congrete, source=Web Response
      No relevant relationships by Debapriya Datta, source=Web Response
      No relevant relationships by Mario Perez, source=Web Response