Key result
Admission lactate ≥ 4.3 mmol/L linked to ~36-fold higher intra-hospital mortality in intermediate-high risk PE.
Why the study?
Intermediate-high risk pulmonary embolism is a heterogeneous category with variable mortality, making it crucial to identify parameters to better stratify patients at higher risk of deterioration requiring prompt reperfusion strategies.
Do admission lactate levels ≥ 4.3 mmol/L and PESI score ≥ 4 predict intra-hospital mortality in intermediate-high risk pulmonary embolism patients?
Observational (n=173)
Yes
Do admission lactate levels ≥ 4.3 mmol/L and PESI score ≥ 4 predict intra-hospital mortality in intermediate-high risk pulmonary embolism patients?
Effect estimate: OR 36 (95% CI 3.4-378)
p-value: p=0.003
In intermediate-high risk pulmonary embolism patients, admission lactate ≥ 4.3 mmol/L strongly predicts intra-hospital mortality, while the combination of lactate < 4.3 mmol/L and PESI < 4 has a 100% negative predictive value for in-hospital death.
May support lactate integration into PE risk models; hypothesis-generating and requires prospective validation before clinical use.
Background Risk stratification for pulmonary embolism (PE) is a cornerstone for identification of patients at high risk of mortality and PE-related complications. Intermediate-high risk correspond to an heterogenous class, with mortality ranging from 3 to 12%. It becomes crucial to better stratify, among intermediate-high risk patients, those at higher risk of deterioration who need prompt strategies of reperfusion to extend the current ESC classification. Purpose The USAT IH-PE registry is a retrospective and prospective multicenter registry of patients treated with ultrasoud-faciltated catheter directed thrombolysis. The aim of this sub-analysis is to determine specific parameters related to worse prognosis in PE patients at intermediate-high risk. Methods From march 2018 to november 2024 173 patients at intermediate-high risk were included. The majority were female (52%), with a mean age of 66 (55-74) years old. Only 5.5% were affected by heart failure (HF) and 11% by chronic kidney disease. The primary endpoint was intra-hospital mortality with respect to Pulmonary Embolism Severity Index (PESI) score ≥ 4, lactate level ≥ 4.3 mmol/L (found through the Youden J statistic) and the combination of the two at the admittance in the emergency room. Results A level of lactates ≥ 4.3 mmol/L was associated with increased mortality (OR 36, 95% CI 3.4-378, p = 0.003). PESI class ≥ 4 exhibited a trend toward higher mortality (OR 5.8, 95% IC 0.59-57.41, p = 0.124). The combination of PESI score < 4 and lactates < 4.3 mmol/L was associated with favorable in-hospital outcome (NPV 100%, p = 0.015). Conclusions the results of the present sub-analysis identified possible additional parameters that can better stratify intermediate-high risk patients. By using PESI score and lactate levels at admission in the emergency room, the clinician can easily identify the patients at higher risk of a worse prognosis needing prompt intervention. Further studies are needed to confirm these data or expand the pool of diagnostic tools.
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Colombo et al. (2025) conducted an observational in Acute pulmonary embolism (intermediate-high risk) (n=173). Risk stratification using lactate level ≥ 4.3 mmol/L and PESI score ≥ 4 vs. Lower lactate levels and PESI scores was evaluated on Intra-hospital mortality (OR 36, 95% CI 3.4-378, p=0.003). Admission lactate levels ≥ 4.3 mmol/L were associated with increased intra-hospital mortality in intermediate-high risk pulmonary embolism patients (OR 36; 95% CI 3.4-378; p=0.003).
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