Objectives: Acute pulmonary embolism(PE) is a common and fatal complication of venous thromboembolism. Following diagnosis, clinical scoring systems (PESI, sPESI), imaging modalities for right ventricular dysfunction, or blood biomarkers are used to determine prognosis and new parameters and combined scoring systems continue to be developed. Our aim is to evaluate the effectiveness of the PESI score and lactate levels in arterial blood gas for predicting 30-day mortality in patients with PE in the emergency department(ED).
Materials and Methods: This study is a retrospective cross-sectional study conducted between January 1, 2016, and December 31, 2017. A total of 190 patients aged 18 years and older who presented to the adult ED with diagnosed with acute PE by pulmonary multi-detector computed tomography (MDCT) were retrospectively screened through the hospital record management system and patient files. The PESI score was calculated using the patient data obtained and the lactate value in the arterial blood gas analysis was recorded. Deaths within 30 days were examined using the hospital document management system and the Ministry of Health Death Reporting System. The statistical significance of lactate, PESI, troponin, right ventricular dysfunction and the presence of infection accompanying PE in predicting 30-day mortality was evaluated.
Key Findings: Out of 190 patients, 40 (21.1%) died within 30 days. PESI classes were found to be statistically significant in assessing 30-day mortality (p<0.001). The sensitivity of PESI was found to be 75%, and the specificity was 74%. Death was observed within 30 days in 28 (17.2%) of 163 patients with low lactate levels and in 12 (44.4%) of 27 patients with high lactate levels (p=0.001). The sensitivity of plasma lactate was 30%, specificity 90%; the sensitivity of PESI and lactate was 80%, specificity 71.3%. When lactate, PESI Class IV, and PESI Class V values were analyzed using logistic regression, the contribution of lactate to predicting mortality was statistically significant when PESI was present (p=0.033).
Implications: In patients diagnosed with acute PE, when PESI and lactate are evaluated together in prognosis assessment, they are found to be more powerful in predicting mortality than PESI alone.