Natriuretic peptides and troponins in pulmonary embolism: a meta-analysis
| Autor: | Steeve Provencher, Lajmi Lakhal, Yves Lacasse, Jean-Christophe Lega |
|---|---|
| Přispěvatelé: | Centre de Recherche en Astronomie Astrophysique et Géophysique (CRAAG) |
| Jazyk: | angličtina |
| Rok vydání: | 2009 |
| Předmět: |
Pulmonary and Respiratory Medicine
MESH: Pulmonary Embolism medicine.medical_specialty medicine.drug_class 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Natriuretic peptide 030212 general & internal medicine MESH: Natriuretic Peptides Adverse effect MESH: Ventricular Dysfunction Right MESH: Humans biology business.industry Vascular disease Respiratory disease MESH: Biological Markers Odds ratio MESH: ROC Curve medicine.disease Troponin 3. Good health Pulmonary embolism Endocrinology Meta-analysis biology.protein Cardiology [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology MESH: Troponin business |
| Zdroj: | Thorax Thorax, BMJ Publishing Group, 2009, 64 (10), pp.869-75. ⟨10.1136/thx.2008.110965⟩ |
| ISSN: | 0040-6376 |
| DOI: | 10.1136/thx.2008.110965⟩ |
| Popis: | International audience; BACKGROUND: The role of biomarkers such as B-type natriuretic peptides (BNP and NT-proBNP) and troponins in risk stratification of acute pulmonary embolism (APE) is still debated. A meta-analysis was performed to assess the association between raised natriuretic peptide levels, alone or in conjunction with troponins, and all-cause and APE-related mortality, serious adverse events and echographic right ventricular dysfunction. METHODS: MEDLINE and EMBASE databases were searched and conference abstracts were hand searched up to February 2008. Studies were included if a 2x2 table could be constructed based on natriuretic peptide results and at least one of the outcomes. RESULTS: Twenty-three studies were included (1127 patients). Raised natriuretic peptide levels were significantly associated with all-cause mortality (odds ratio (OR) 6.2; 95% confidence interval (CI) 3.0 to 12.7), APE-related mortality (OR 5.0; 95% CI 2.2 to 11.5) and serious adverse events (OR 6.7; 95% CI 3.9 to 11.6), with homogeneity across studies. Among patients with raised natriuretic peptide levels, increased serum troponins were associated with a further increase in the risk of adverse outcomes. Analysis of the accuracy of natriuretic peptides in detecting right ventricular dysfunction was limited by heterogeneity across studies. BNP appeared to have better sensitivity and specificity than NT-proBNP in detecting right ventricular dysfunction. CONCLUSIONS: Raised levels of B-type natriuretic peptides identified a subset of patients with APE at higher risk of adverse outcomes. Among patients with raised natriuretic peptide levels, increased troponins were found to be an independent prognostic marker. The results of this meta-analysis may have important clinical implications in the management of APE. |
| Databáze: | OpenAIRE |
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