Department of Cardiology and Angiology, Campus Charité Mitte (CCM), Charité - University Medicine Berlin, Germany; German Center for Cardiovascular Research (DZHK), Partner site Berlin, Germany.
Clinic of Cardiology and Pneumology, University Medical Center Göttingen, Germany.
Eur J Intern Med. 2021 Apr;86:25-31. doi: 10.1016/j.ejim.2021.01.021. Epub 2021 Feb 6.
Arterial lactate is an established risk marker in patients with pulmonary embolism (PE). However, its clinical applicability is limited by the need of an arterial puncture. In contrast, venous lactate can easily be measured from blood samples obtained via routine peripheral venepuncture.
We investigated the prognostic value of venous lactate with regard to in-hospital adverse outcomes and mortality in 419 consecutive PE patients enrolled in a single-center registry between 09/2008 and 09/2017.
An optimised venous lactate cut-off value of 3.3 mmol/l predicted both, in-hospital adverse outcome (OR 11.0 [95% CI 4.6-26.3]) and all-cause mortality (OR 3.8 [95%CI 1.3-11.3]). The established cut-off value for arterial lactate (2.0 mmol/l) and the upper limit of normal for venous lactate (2.3 mmol/l) had lower prognostic value for adverse outcomes (OR 3.6 [95% CI 1.5-8.7] and 5.7 [95% CI 2.4-13.6], respectively) and did not predict mortality. If added to the 2019 European Society of Cardiology (ESC) algorithm, venous lactate <2.3 mmol/l was associated with a high negative predictive value (0.99 [95% CI 0.97-1.00]) for adverse outcomes in intermediate-low-risk patients, whereas levels ≥3.3 mmol/l predicted adverse outcomes in the intermediate-high-risk group (OR 5.2 [95% CI 1.8-15.0]).
Venous lactate above the upper limit of normal was associated with increased risk for adverse outcomes and an optimised cut-off value of 3.3 mmol/l predicted adverse outcome and mortality. Adding venous lactate to the 2019 ESC algorithm may improve risk stratification. Importantly, the established cut-off value for arterial lactate has limited specificity in venous samples and should not be used.
动脉乳酸是肺栓塞（PE）患者的既定风险标志物。然而，由于需要动脉穿刺，其临床适用性受到限制。相比之下，静脉乳酸可以通过常规外周静脉穿刺获得的血液样本轻松测量。
我们研究了 419 例连续 PE 患者的静脉乳酸的预后价值，这些患者是在 2008 年 9 月至 2017 年 9 月期间在一个单中心登记处登记的。
优化的静脉乳酸截断值为 3.3mmol/l 可预测院内不良结局（OR 11.0 [95%CI 4.6-26.3]）和全因死亡率（OR 3.8 [95%CI 1.3-11.3]）。动脉乳酸的既定截断值（2.0mmol/l）和静脉乳酸的正常上限值（2.3mmol/l）对不良结局的预测价值较低（OR 3.6 [95%CI 1.5-8.7]和 5.7 [95%CI 2.4-13.6]），也不能预测死亡率。如果将静脉乳酸<2.3mmol/l 添加到 2019 年欧洲心脏病学会（ESC）算法中，那么中间低危患者的不良结局具有高阴性预测值（0.99 [95%CI 0.97-1.00]），而水平≥3.3mmol/l 则可预测中间高危组的不良结局（OR 5.2 [95%CI 1.8-15.0]）。
静脉乳酸超过正常上限与不良结局风险增加相关，优化的截断值 3.3mmol/l 可预测不良结局和死亡率。将静脉乳酸添加到 2019 年 ESC 算法中可能会改善风险分层。重要的是，动脉乳酸的既定截断值在静脉样本中的特异性有限，不应使用。
