Soontharee Congrete, MD, on Lactic Acid as a Prognostic Tool for Submassive Pulmonary Embolism

In this podcast, Soontharee Congrete, MD, talks about her team's latest study that investigated whether lactic acid could help determine which patients with pulmonary embolism have a high risk for decompensation.

Additional Resource:

• Congrete S. Admission lactate and outcome in intermediate risk (submassive) pulmonary embolism. Paper presented at: CHEST 2021;October 17-20, 2021;Virtual. https://journal.chestnet.org/article/S0012-3692(21)03477-2/fulltext

Soontharee Congrete, MD, is a fellow at the University of Connecticut School of Medicine.

TRANSCRIPT:

Amanda Balbi: Hello everyone, and welcome to another installment of Podcasts360—your go-to resource for medical news and clinical updates. I’m your moderator, Amanda Balbi with Consultant360.

Today we’re speaking with a researcher who is presenting her team’s latest study at CHEST 2021. Her name is Soontharee Congrete, MD, and she is a fellow at the University of Connecticut School of Medicine.

Thank you for joining us today, Dr Congrete. To start, can you give us a brief overview of the study you presented at CHEST 2021?

Soontharee Congrete: Absolutely. Our research study is about lactic acid, which is a serum marker and its associated outcomes in intermediate risk submassive pulmonary embolism. This type of PE is the PE without hypotension or the right heart dysfunction. We know that 5% to 6.5% of this population actually decompensate to massive or high-risk PE. So, who is at risk for decompensation?

Nowadays, we have the prognostic or risk stratification tool, which is the Bova score that can predict the mortality in 30 days for submassive pulmonary embolism, but it does not include the serum lactic acid, which is actually generally used in other diseases like sepsis to predict morbidity and mortality, as well as the hemodynamic decompensation.

What we did was we looked back at the data for the patients who were admitted at The John Dempsey Hospital at the University of Connecticut. For 54 patients admitted with a submassive PE, we took a look at the serum lactic acid and the outcomes, which include death, hemodynamic decompensation, and respiratory failure. We found significant association between serum lactic acid and outcomes, including the hemodynamic decompensation, the need for oxygen, the need of invasive ventilation, noninvasive ventilation, and death.

In summary, our study results indicate that serum lactic acid is associated with hemodynamic decompensation, death, and respiratory failure in submassive PE.

Amanda Balbi: Did any patient characteristics specifically impact those results?

Soontharee Congrete: Not really. On average, the age was 60 years or so, maybe slightly male predominance, but we didn't find any race, ethnic group, or any subgroup that would have more trends towards this finding.

Amanda Balbi: All right. So then, what would you say are the clinical takeaway messages from your study, and how can HCPs implement those into their practice?

Soontharee Congrete: Sure. From our study, the lactic acid indicates a risk of hemodynamic decompensation, the risk of respiratory failure, and also death in submassive intermediate-risk PE. This should be obtained routinely in all patients with submassive PE.

In clinical practice, it could be integrated into the prognostic tools to guide the treatment in submassive intermediate-risk PE, which is pretty much in the gray zone in terms of treatment in addition to anticoagulation right now, for example, the thrombolytic therapy or the catheter-directed thrombolytic therapy.

Amanda Balbi: You had mentioned that it would impact the treatment options. Can you talk more about that?

Soontharee Congrete: So, we know that for massive PE—so with the patient who has a significant hemodynamic decompensation, like hypotension or cardiac arrest—the treatment is thrombolytic therapy. For submassive PE, it is not as severe as massive PE yet, and based on current evidence, we don't know if we give those patients thrombolytic therapy or catheter-directed thrombolytic therapy it would help in terms of the outcomes or prevent death.

Again, we need more prognostic factors, tools in this population in order to determine advanced treatment in addition to anticoagulation, which is the mainstay therapy of any type of PE.

Amanda Balbi: And so, what is the next step in your research in this area?

Soontharee Congrete: Having lactic acid as a validated prognostic factor to aid in determining outcomes and treatment in submassive intermediate-risk PE would be very helpful, so we need more studies, especially with a larger sample size to validate this finding in order to develop those prognostic tools.

Amanda Balbi: Is there anything else that you wanted to add or any final thoughts?

Soontharee Congrete: I am hopeful that we can get more data and develop more validated prognostic tools in this population, because nowadays, we have a lot of treatment in addition to just the anticoagulation for PE, but we don’t know who is the ideal candidates that we should consider that.

Amanda Balbi: Thank you so much for speaking with me today and answering my questions.

Soontharee Congrete: Absolutely! It was a pleasure.