Key result
Admission lactate in intermediate-risk PE links to hypotension, mechanical ventilation, and mortality.
Why the study?
Limited information exists on factors that might predict adverse outcomes in intermediate-risk pulmonary embolism.
Do admission lactate and troponin levels correlate with adverse clinical outcomes in patients with intermediate-risk pulmonary embolism?
Cohort (n=48)
No
Do admission lactate and troponin levels correlate with adverse clinical outcomes in patients with intermediate-risk pulmonary embolism?
Admission lactate, but not troponin, correlates with hemodynamic decompensation, respiratory failure, and mortality in intermediate-risk pulmonary embolism.
May support incorporating admission lactate and troponin into IR-PE risk models; leaves open prospective validation for guiding interventions.
Introduction Intermediate-Risk Pulmonary Embolism (PE) [IR-PE] is PE with large clot burden causing right ventricle strain and /or myocardial necrosis, without hypotension. This requires rapid risk-stratification and intervention as a significant number can progress to high-risk (massive) PE, with a reported mortality rate of 2.9%. Limited information exists on factors that might predict outcomes in IR- PE. This study aims to determine whether admission lactate and troponin and rise in troponin (δ-Troponin) correlate with outcomes in IR-PE. Methods Medical records of 48 patients admitted to our institution with IR-PE over a 6- year-period were reviewed. Age, gender, admission lactate, and troponin levels were noted. δ-Troponin was calculated as highest troponin - admission troponin. Outcomes studied: occurrence of hypotension requiring pressors, need for mechanical ventilation (MV)- invasive or non-invasive; in-hospital mortality. Pearson’s correlation analysis was performed to assess the relation of admission troponin and δ-troponin to studied outcomes. p ≤ 0.05 was deemed statistically significant. Results Mean age was 68+17 yrs; 39.5% were males. Mean admission lactate was: 1.95 + 1.04 mmol/L ; mean troponin was 0.2 + 0.3 ng/ml; mean δ-Troponin: 0.59 + 1.4 ng/ml. Eight patients (16%) became hypotensive requiring pressors; 5 (10%) underwent ST; 10 (20%) underwent CDT and 1 patient expired (2%). Pearson’s correlation analysis indicated a significant correlation between admission lactate and development of hypotension (r = 0.28, p < 0.05); mortality (r= -0.311, p = 0.04), need for MV (r = 0.409, p = 0.006); need for ST (r = 0.436, p = 0.03) or CDT (r = 0.436, p = 0.03). Pearson’s correlation analysis indicated no significant correlation between admission troponin and respectively, hypotension requiring pressors (r = 0.016,p=0.9); mortality (r= -0.016, p = 0.2) and need for MV (r = 0.81,p=0.6). Similarly, no significant correlation was seen between δ-troponin and above outcomes. Conclusions Admission lactate in Intermediate-risk PE indicates risk for hemodynamic decompensation, death, respiratory failure and should be routinely performed in these cases. Clinical Implications Lactate should be routinely obtained in Intermediate-Risk Pulmonary Embolism to predict hemodynamic decompensation, death, and respiratory failure outcomes. Whether troponin rise can predict hemodynamic decompensation needs to be further studied.
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Lewkowicz et al. (2026) conducted a cohort in Intermediate-Risk Pulmonary Embolism (n=48). Admission lactate and troponin was evaluated on Hypotension requiring pressors, mechanical ventilation, in-hospital mortality, and need for thrombolysis (r = 0.28 (hypotension), p=<0.05). Admission lactate in intermediate-risk pulmonary embolism significantly correlated with hypotension (r=0.28, p<0.05), mortality (r=-0.311, p=0.04), and mechanical ventilation (r=0.409, p=0.006).
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