Cardiac biomarkers for risk stratification in non-massive pulmonary embolism: a multicenter prospective study

Autor: Jean-Charles Sanchez, Nicolas Vuilleumier, Natacha Turck, G. Le Gal, Arnaud Perrier, Thomas V. Perneger, Noury Mensi, Denis F. Hochstrasser, Marc Philip Righini, F. Verschuren, Henri Bounameaux
Přispěvatelé: Division of Laboratory Medicine (DLM), Geneva University Hospital (HUG), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Emergency Department (FV - ED), Saint Luc University Hospital, Service de médecine interne générale (SMIG), Hôpital Universitaire de Genève, Service d'angiologie et d'hémostase (MR), Biomedical Proteomic Research Group (BPRG), University Medical Centre of Geneva, Biomedical Proteomics Research Group (BPRG), Centre médical universitaire, Division of Clinical Epidemiology (DCE)
Jazyk: angličtina
Rok vydání: 2009
Předmět:
MESH: Pulmonary Embolism
030204 cardiovascular system & hematology
Chest pain
MESH: Risk Assessment
Gastroenterology
0302 clinical medicine
Natriuretic Peptide
Brain
Odds Ratio
030212 general & internal medicine
MESH: Natriuretic Peptide
Brain
Prospective Studies
Prospective cohort study
MESH: Peptide Fragments
ddc:616
Univariate analysis
MESH: Middle Aged
Area under the curve
Hematology
Middle Aged
Prognosis
Troponin/blood
Troponin
MESH: Predictive Value of Tests
3. Good health
Pulmonary embolism
MESH: Young Adult
Predictive value of tests
Biological Markers
Female
medicine.symptom
Adult
medicine.medical_specialty
Adolescent
Fibrin Fibrinogen Degradation Products/analysis
Fatty Acid-Binding Proteins
MESH: Fatty Acid-Binding Proteins
Risk Assessment
MESH: Prognosis
Fibrin Fibrinogen Degradation Products
Pulmonary Embolism/*diagnosis
03 medical and health sciences
Young Adult
Predictive Value of Tests
Internal medicine
medicine
MESH: Fibrin Fibrinogen Degradation Products
Humans
ddc:576
ddc:613
MESH: Adolescent
MESH: Humans
business.industry
MESH: Biological Markers
MESH: Adult
Odds ratio
medicine.disease
Peptide Fragments
Confidence interval
MESH: Prospective Studies
MESH: Odds Ratio
Surgery
MESH: Troponin
Natriuretic Peptide
Brain/blood
Pulmonary Embolism
business
Peptide Fragments/blood
MESH: Female
Biomarkers
[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Fatty Acid-Binding Proteins/blood
Zdroj: Journal of Thrombosis and Haemostasis, Vol. 7, No 3 (2009) pp. 391-398
Journal of Thrombosis and Haemostasis
Journal of Thrombosis and Haemostasis, Wiley, 2009, 7 (3), pp.391-8. ⟨10.1111/j.1538-7836.2008.03260.x⟩
ISSN: 1538-7836
1538-7933
DOI: 10.1111/j.1538-7836.2008.03260.x⟩
Popis: International audience; BACKGROUND: Troponins (cTnI and cTnT), N-terminal pro-Brain Natriuretic Peptide (NT-proBNP), myoglobin, heart-type fatty acid-binding protein (H-FABP) and fibrin D-Dimer are emergent candidates for risk stratification in pulmonary embolism (PE). OBJECTIVE: To compare the respective prognostic values of biomarker with non-massive PE to predict an adverse outcome at 3 months. PATIENTS/METHODS: One hundred and forty-six consecutive patients with non-massive PE were included in this multicenter prospective study. The combined outcome consisted of intensive care monitoring on admission, death or hospitalization attributable to either a PE-related complication [defined by PE/deep vein thrombosis (DVT) relapse or major bleeding under anticoagulation] or to dyspnoea with or without chest pain during follow-up. RESULTS: The outcome was met in 12% of patients. In univariate analysis, a NT-proBNP level above 300 pg/ml was the strongest predictor of unfavorable outcome with an odds ratio (OR) of 15.8 [95% confidence interval (CI): 2.05-122). ORs for the other variables were: 8.0 for D-dimer >2000 ng/ml (95% CI: 1.1-64), 4.7 for H-FABP >6 ng/ml (95% CI:1.5-14.8), 3.5 for cTnI >0.09 ng/ml (95% CI:1.2-9.7), 3.4 for myoglobin >70 ng/ml (95% CI:0.9-12.2). Receiver operating curve (ROC) analysis indicated that NT-proBNP was the best predictor [area under the curve (AUC) 0.84; 95%CI: 0.76-0.92; P < 0.0001] with a negative predictive value of 100% (95% CI: 91-100) at 300 pg/ml. At that cut-off, the true negative rate for NT-proBNP was 40%. In multivariate analysis, NT-proBNP was the only significant independent predictors. CONCLUSIONS: NT-proBNP appears to be a good risk stratification marker in identifying low-risk patients with non-massive PE who could be treated in an outpatient setting.
Databáze: OpenAIRE
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