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Venous lactate: The new “magic marker” for stratification in intermediate-risk pulmonary embolism?

  • Nicolas Meneveau
    Correspondence
    Correspondence to: Department of Cardiology, EA3920, University Hospital Jean Minjoz, Boulevard Fleming, 25000 Besançon, France
    Affiliations
    University Hospital Besancon, and EA3920, University of Franche-Comté, Besancon, France
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Published:March 18, 2021DOI:https://doi.org/10.1016/j.ejim.2021.03.004
      Risk stratification in patients with acute pulmonary embolism (PE) is essential to guide the choice of appropriate therapy. The stratification of risk is first and foremost based on the presence of signs of hemodynamic instability, which is associated with a very high risk of early death, but affects only around 5% of PE patients. For the vast majority of normotensive PE patients, it is recommended to proceed with imaging, mainly to investigate the presence of right ventricular (RV) dysfunction, and laboratory indicators of PE severity (mostly deriving from the presence of RV dysfunction). In addition, the presence of comorbidities should be investigated, or any other aggravating condition that could negatively affect early prognosis. Clinical, imaging and biology results are all directly related to the severity of PE and to the risk of early PE-related death, whereas information about comorbidities and aggravating conditions are necessary to assess the patient's overall risk of death.
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      References

        • Bova C
        • Sanchez O
        • Prandoni P
        • Lankeit M
        • Konstantinides S
        • Vanni S
        • Jimenez D
        Identification of intermediate-risk patients with acute symptomatic pulmonary embolism.
        Eur Respir J. 2014; 44: 694-703
        • Hobohm L
        • Hellenkamp K
        • Hasenfuss G
        • Munzel T
        • Konstantinides S
        • Lankeit M
        Comparison of risk assessment strategies for not-high-risk pulmonary embolism.
        Eur Respir J. 2016; 47: 1170-1178
        • Meyer G
        • Vicaut E
        • Danays T
        • Agnelli G
        • Becattini C
        • Beyer-Westendorf J
        • Bluhmki E
        • Bouvaist H
        • Brenner B
        • Couturaud F
        • Dellas C
        • Empen K
        • Franca A
        • Galie N
        • Geibel A
        • Goldhaber SZ
        • Jimenez D
        • Kozak M
        • Kupatt C
        • Kucher N
        • Lang IM
        • Lankeit M
        • Meneveau N
        • Pacouret G
        • Palazzini M
        • Petris A
        • Pruszczyk P
        • Rugolotto M
        • Salvi A
        • Schellong S
        • Sebbane M
        • Sobkowicz B
        • Stefanovic BS
        • Thiele H
        • Torbicki A
        • Verschuren F
        • Konstantinides SV
        Fibrinolysis for patients with intermediate-risk pulmonary embolism.
        N Engl J Med. 2014; 370: 1402-1411
        • Goldhaber SZ
        • Visani L
        • De Rosa M
        Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER).
        Lancet. 1999; 353: 1386-1389
        • Becattini C
        • Agnelli G
        • Lankeit M
        • Masotti L
        • Pruszczyk P
        • Casazza F
        • Vanni S
        • Nitti C
        • Kamphuisen P
        • Vedovati MC
        • De Natale MG
        • Konstantinides S
        Acute pulmonary embolism: mortality prediction by the 2014 European Society of Cardiology risk stratification model.
        Eur Respir J. 2016; 48: 780-786
        • Kasper W
        • Konstantinides S
        • Geibel A
        • Olschewski M
        • Heinrich F
        • Grosser KD
        • Rauber K
        • Iversen S
        • Redecker M
        • Kienast J
        Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry.
        J Am Coll Cardiol. 1997; 30: 1165-1171
        • Chatterjee S
        • Chakraborty A
        • Weinberg I
        • Kadakia M
        • Wilensky RL
        • Sardar P
        • Kumbhani DJ
        • Mukherjee D
        • Jaff MR
        • Giri J
        Thrombolysis for pulmonary embolism and risk of all-cause mortality, major bleeding, and intracranial hemorrhage: a meta-analysis.
        JAMA. 2014; 311: 2414-2421
        • Secemsky E
        • Chang Y
        • Jain CC
        • Beckman JA
        • Giri J
        • Jaff MR
        • Rosenfield K
        • Rosovsky R
        • Kabrhel C
        • Weinberg I
        Contemporary Management and Outcomes of Patients with Massive and Submassive Pulmonary Embolism.
        Am J Med. 2018; 131 (1506-1514): e0
        • Kucher N
        • Goldhaber SZ
        Cardiac biomarkers for risk stratification of patients with acute pulmonary embolism.
        Circulation. 2003; 108: 2191-2194
        • Coutance G
        • Cauderlier E
        • Ehtisham J
        • Hamon M
        The prognostic value of markers of right ventricular dysfunction in pulmonary embolism: a meta-analysis.
        Crit Care. 2011; 15: R103
        • Konstantinides SV
        • Meyer G
        • Becattini C
        • Bueno H
        • Geersing GJ
        • Harjola VP
        • Huisman MV
        • Humbert M
        • Jennings CS
        • Jimenez D
        • Kucher N
        • Lang IM
        • Lankeit M
        • Lorusso R
        • Mazzolai L
        • Meneveau N
        • Ni Ainle F
        • Prandoni P
        • Pruszczyk P
        • Righini M
        • Torbicki A
        • Van Belle E
        • 2019 Zamorano JL:
        ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS).
        Eur Heart J. 2020; 41: 543-603
        • Thiele H
        • Ohman EM
        • Desch S
        • Eitel I
        • de Waha S
        Management of cardiogenic shock.
        Eur Heart J. 2015; 36: 1223-1230
        • Vanni S
        • Jimenez D
        • Nazerian P
        • Morello F
        • Parisi M
        • Daghini E
        • Pratesi M
        • Lopez R
        • Bedate P
        • Lobo JL
        • Jara-Palomares L
        • Portillo AK
        • Grifoni S
        Short-term clinical outcome of normotensive patients with acute PE and high plasma lactate.
        Thorax. 2015; 70: 333-338
        • Vanni S
        • Nazerian P
        • Bova C
        • Bondi E
        • Morello F
        • Pepe G
        • Paladini B
        • Liedl G
        • Cangioli E
        • Grifoni S
        • Jimenez D
        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.
        Intern Emerg Med. 2017; 12: 657-665
        • Ebner M
        • Pagel CF
        • Sentler C
        • Harjola VP
        • Bueno H
        • Lerchbaumer MH
        • Stangl K
        • Pieske B
        • Hasenfuß G
        • Konstantinides SV
        • Lankeit M
        Venous lactate improves the prediction of in-hospital adverse outcomes in normotensive pulmonary embolism.
        Eur J Intern Med. 2021; https://doi.org/10.1016/j.ejim.2021.01.021
        • Lankeit M
        • Jimenez D
        • Kostrubiec M
        • Dellas C
        • Hasenfuss G
        • Pruszczyk P
        • Konstantinides S
        Predictive value of the high-sensitivity troponin T assay and the simplified Pulmonary Embolism Severity Index in hemodynamically stable patients with acute pulmonary embolism: a prospective validation study.
        Circulation. 2011; 124: 2716-2724
        • Becattini C
        • Vedovati MC
        • Agnelli G
        Prognostic value of troponins in acute pulmonary embolism: a meta-analysis.
        Circulation. 2007; 116: 427-433
        • Becattini C
        • Agnelli G
        Predictors of mortality from pulmonary embolism and their influence on clinical management.
        Thromb Haemost. 2008; 100: 747-751
        • Giri J
        • Sista AK
        • Weinberg I
        • Kearon C
        • Kumbhani DJ
        • Desai ND
        • Piazza G
        • Gladwin MT
        • Chatterjee S
        • Kobayashi T
        • Kabrhel C
        • Barnes GD
        Interventional Therapies for Acute Pulmonary Embolism: Current Status and Principles for the Development of Novel Evidence: A Scientific Statement From the American Heart Association.
        Circulation. 2019; 140: e774-e801