Prognostic Value of Plasma Lactate Levels Among Patients With Acute Pulmonary Embolism: The Thrombo-Embolism Lactate Outcome Study

Vanni, Simone; Viviani, Gabriele; Baioni, Michele; Pepe, Giuseppe; Nazerian, Peiman; Socci, Filippo; Bartolucci, Maurizio; Bartolini, Marco; Grifoni, Stefano

doi:10.1016/j.annemergmed.2012.10.022

Cited by 91 publications

(81 citation statements)

References 26 publications

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“…However, data from large observational cohort studies show that no single marker is able to identify intermediate-high risk patients [7,22,23], and that a multi-marker approach appears to be more suitable [24][25][26][27][28]. Recently, two multimaker prognostic tools have been derived and validated in large cohort studies, the Bova and the TELOS scores [10][11][12][13][14][15][16]. These two scores have been proposed for identification of patients at intermediate-high risk, but their efficiency has not been compared so far.…”

Section: Discussionmentioning

confidence: 96%

“…We used logistic regression to assess for an independent association between potential baseline predictors and the outcome in the cohort [14]. With the backward stepwise multivariable logistic regression model, we assessed the prognostic information of lactate concentration on top of the variables included in the Bova score (Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…This was a retrospective study analyzing prospective data collected from two monocentric [14,15] and one multicenter [16] cohort studies, enrolling consecutive outpatients admitted for symptomatic PE, from September 2002 to January 2014. Data from these studies have not been used before for derivation or validation of the ESC 2014 model and of the Bova score.…”

Section: Study Design and Settingmentioning

confidence: 99%

“…Two monocentric studies [14,15] indicate that plasma lactate determination should be a candidate for short-term prognostication in PE, and one multicenter prospective study, the Thrombo-embolism lactate outcome study (TELOS) [16], further proposes to classify at intermediate-high risk the patients showing RV dysfunction together with elevated troponin and elevated plasma lactate concentrations.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of clinical scores for identification of patients with pulmonary embolism at intermediate–high risk of adverse clinical outcome: the prognostic role of plasma lactate

et al. 2016

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To compare the prognostic accuracy of the 2014 risk model of the European Society of Cardiology (ESC) and of Bova and TELOS scores for identification of normotensive patients with pulmonary embolism (PE) at high risk for short-term adverse events (i.e., intermediate-high risk patients), we retrospectively applied these tests to a prospective cohort of 994 normotensive patients with objectively confirmed PE. Sixty-three (6.3 %) patients reached the primary outcome, a composite of hemodynamic collapse and death within 7 days from diagnosis. The Bova and TELOS scores classified the same proportion of patients in intermediate-high risk category (5.9 and 5.7 %, respectively), with a similar primary outcome rate (18.6 and 21.1 %, respectively). The 2014 ESC model classified in the intermediate-high risk category the largest proportion of patients (12.5 %, p < 0.001 vs Bova and TELOS), with the lowest primary outcome rate (13 %, p = ns vs Bova and TELOS). When lactate determination was added to the Bova score, 112 patients (11.2 %) were classified in the intermediate-high risk category (p < 0.05 vs Bova and TELOS), with a slight increase in the primary outcome rate (25.9 %, p = 0.014 vs 2014 ESC model), allowing the recognition of a twofold higher number of patients reaching the primary outcome (29 vs 15, 11 and 12 patients in the 2014 ESC model, Bova and TELOS scores, respectively, p < 0.01 for all). The 2014 ESC model, Bova and TELOS scores identify a small number of intermediate-high risk patients with PE, without differences among tests. Adding plasma lactate to the Bova score significantly improves the identification of intermediate-high risk patients.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Study Design and Settingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of clinical scores for identification of patients with pulmonary embolism at intermediate–high risk of adverse clinical outcome: the prognostic role of plasma lactate

et al. 2016

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“…Investigators from Florence, Italy, recently showed an increased plasma lactate level of 2 mmol/L or greater in patients with PE was associated with an increased risk of death (HR 11.67; 95 % CI 3.32-41.03) [83]. This increased risk was independent of shock, RV dysfunction, or elevation of troponin I levels.…”

Section: Plasma Lactatementioning

confidence: 86%

Expedited Management of Deep Vein Thrombosis and Acute Pulmonary Embolism

Johnson

Yarbrough

2013

Curr Emerg Hosp Med Rep

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Deep vein thrombosis and pulmonary embolism are common diseases with significant morbidity and mortality. Clinical probability assessment reliably identifies low-risk patients, and when paired with a negative D-dimer test, safely excludes venous thromboembolism. Compression ultrasonography confirms the diagnosis of deep vein thrombosis, whereas computed tomography pulmonary angiography is typically used to confirm pulmonary embolism. Risk assessment of acute pulmonary embolism stratifies low-risk patients for outpatient treatment, and high-risk patients for consideration of thrombolytic therapy. The recent approval of rivaroxaban, a novel oral anticoagulant, can simplify and expedite treatment in select patients. Ongoing clinical trials may uncover methods to prevent postthrombotic syndrome and chronic thromboembolic pulmonary hypertension. In this report, we review current diagnostic and management methods for deep vein thrombosis and pulmonary embolism.

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