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Lactate predicts short-term mortality in acute pulmonary embolism more accurately than shock index and modified shock index
Session:
CO 19 - Cuidados Intensivos
Speaker:
Joana Vieira Simoes
Congress:
CPC 2018
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.2 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Joana Simões; João Bicho Augusto; Frederico Pinto Da Costa; David Cabrita Roque; Miguel Borges Dos Santos; Carlos Sequeira De Morais
Abstract
<p><strong>BACKGROUND</strong>: Increasing blood lactate concentrations are more closely related to outcome than blood pressure, particularly in sepsis. Shock index (SI) and modified shock index (MSI) have been shown to predict adverse prognosis in severe trauma, heart failure, and acute coronary syndromes. Data on lactate, SI and MSI as prognostic factors in acute pulmonary embolism (PE) are scarce.</p> <p><strong>PURPOSE</strong>: We aimed to (1) evaluate whether blood lactate, SI and MSI are associated with short-term mortality in acute PE patients; (2) determine the correlation between lactate concentration and SI and MSI; and (3) compare the prognostic accuracies for short-term mortality of lactate, SI and MSI in acute PE patients.</p> <p><strong>METHODS</strong>: We retrospectively reviewed 483 consecutive patients admitted for acute PE in one single emergency department (ED) along 3 years until December 2016. Lactate concentration on arterial blood collected within the first 6 hours after ED admission was recorded. SI was defined as the ratio of heart rate to systolic blood pressure (SI=HR/SBP), and MSI was defined as the ratio of heart rate to mean arterial blood pressure (MSI=HR/MAP). Outcome was all-cause 7-day mortality. Differences in lactate, SI and MSI between non-survivors and survivors groups were analysed by χ2 (chi-square) test. Correlation of lactate to SI and to MSI was evaluated by Pearson correlation coefficient. Prognostic accuracy for all-cause 7-day mortality of lactate, SI and MSI was performed by C-statistical analysis.</p> <p><strong>RESULTS</strong>: Among the 483 acute PE patients comprising study population, mean age was 66.3 ± 17.6 years and 40% (n=192) were male. Mean lactate concentration was 1.65 ± 1.14 mmol/L. Mean SI was 0.73 ± 0.24 and mean MSI was 1.01±0.33. All-cause 7-day mortality was 9.9% (n=48). Compared to survivors, non-survivors had significantly higher lactate concentration (6.80 ± 5.02 mmol/L in non-survivors, vs. 1.96 ± 1.59 mmol/L in survivors, p <0.001), SI (0.97 ± 0.36 in non-survivors vs. 0.71 ± 0.23 in survivors, p <0.001), and MSI [1.33 ± 0.55 in non-survivors vs. 0.97 ± 0.28 in survivors, p <0.001). Lactate had a significantly positive correlation with SI (r=0.353, p<0.001) and MSI (r=0.370, p<0.001). Prognostic accuracy for all-cause 7-day mortality of lactate, SI and MSI was as follows: lactate (AUC=0.856, CI 95% 0.788-0.923, p<0.001), SI (AUC=0.721, CI 95% 0.639-0.803, p<0.001), MSI (AUC=0.720, CI 95% 0.639-0.803, p<0.001). Lactate concentration >2.12 was the optimal cutt-off point (Youden´s index) for prediction of all-cause 7-day mortality (sensitivy=81.1%, specificity=71.5%).</p> <p><strong>CONCLUSIONS</strong>: In our analysis, higher lactate concentration, SI and MSI are all associated with higher short-term mortality in acute PE patients. Lactate prognostic accuracy for short-term mortality is superior to SI and MSI prognostic accuracies. Our study supports the role of lactate, SI and MSI as prognostic factors in acute PE.</p>
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