Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Acad Emerg Med. 2011 Aug;18(8):830-5. doi: 10.1111/j.1553-2712.2011.01128.x.
The objective was to investigate the prognostic value of plasma lactate in patients with acute pulmonary embolism (PE).
This was a retrospective study at the emergency department (ED) of a third-level teaching hospital. The authors considered consecutive patients with a diagnosis of PE established by lung scan or spiral computed tomography (CT) and confirmed by pulmonary angiography if necessary. Only patients for whom plasma lactate levels had been tested within 6 hours from presentation to the ED were included. Primary outcome was in-hospital death due to any cause; secondary outcome was mortality related to PE.
From September 1997 to June 2006, a total of 384 patients were diagnosed with PE in the ED. Of these patients, 287 had registered plasma lactate levels and were included in this analysis. Included patients had a mean age of 70 (SD ± 15 years, range = 18 to 100 years), 163 (57%) were female, 26 (9%) showed systolic blood pressure lower than 100 mm Hg at presentation, and 160 (56%) had echocardiographic evidence of right ventricular dysfunction (RVD). Twenty patients died during their hospital stay (7%). Plasma lactate levels ≥ 2 mmol/L were associated with in-hospital mortality from all causes (odds ratio [OR] = 4.60, 95% confidence interval [CI] = 1.57 to 13.53) and with PE-related mortality (OR = 4.94, 95% CI = 1.38 to 17.63), independent of hypotension or RVD at presentation.
High plasma lactate was associated with increased in-hospital mortality in this sample of patients with acute PE.
本研究旨在探讨急性肺栓塞（PE）患者血浆乳酸水平的预后价值。
这是一项回顾性研究，在三级教学医院的急诊科进行。研究者纳入了经肺扫描或螺旋 CT 确诊的 PE 患者，并在必要时通过肺动脉造影加以证实。仅纳入在急诊科就诊后 6 小时内检测过血浆乳酸水平的患者。主要转归为院内任何原因导致的死亡；次要转归为与 PE 相关的死亡率。
1997 年 9 月至 2006 年 6 月期间，在急诊科共诊断出 384 例 PE 患者。其中，287 例患者的血浆乳酸水平可评估，并纳入本分析。纳入患者的平均年龄为 70（SD ± 15 岁，范围为 18 至 100 岁），163 例（57%）为女性，就诊时收缩压＜100mmHg 的患者有 26 例（9%），存在右心室功能障碍（RVD）的超声心动图证据的患者有 160 例（56%）。20 例患者在住院期间死亡（7%）。血浆乳酸水平≥2mmol/L 与院内全因死亡率（优势比[OR] = 4.60，95%置信区间[CI] = 1.57 至 13.53）和与 PE 相关的死亡率（OR = 4.94，95% CI = 1.38 至 17.63）相关，与就诊时低血压或 RVD 无关。
在本急性 PE 患者样本中，高血浆乳酸与院内死亡率增加相关。
