Prognostic Value of Biomarkers in Acute Non-massive Pulmonary Embolism: A Systematic Review and Meta-analysis

Overview

Journal Lung

Specialty Pulmonary Medicine

Date 2015 Jul 3

PMID 26134045

Citations 16

Authors

Anurag Bajaj

Parul Rathor

Vishal Sehgal

Besher Kabak

Ajay Shetty

Ossama Al Masalmeh

Srikanth Hosur

Affiliations

Soon will be listed here.

Abstract

Background: Various biomarkers have been evaluated to risk stratify patients with acute pulmonary embolism (PE). We aimed to summarize the available evidence to compare the prognostic value of three most widely studied biomarkers in normotensive patients with acute PE.

Method: A systematic literature review of database, including Pubmed, EMBASE and Cochrane, was done. Studies were included if those were done on patients with acute PE and serum troponin or brain natriuretic peptide and N-terminal proBNP (BNP/NT-proBNP) or Heart-type fatty acid-binding protein (H-FABP) assay was done. The primary end point was short-term all-cause mortality. The secondary end points were PE-related mortality and serious adverse events.

Results: All three biomarkers were significantly associated with increased risk for short-term all-cause mortality, PE-related mortality and serious adverse events. All-cause mortality: troponin [odds ratio (OR) 4.80; 95% CI 3.25-7.08, I(2) = 54%], BNP or NT-proBNP (OR 7.98; 95% CI 4.34-14.67, I(2) = 0%); PE-related mortality: troponin (OR 3.80; 95% CI 2.74-5.27, I(2) = 0%), BNP or NT-proBNP (OR 7.57; 95% CI 2.89-19.81, I (2) = 0%) and H-FABP (OR 25.97; 95% CI 6.63-101.66, I(2) = 40%). H-FABP has the lowest negative likelihood ratio (NLR) of 0.17 for mortality followed by high-sensitive cardiac troponin T (hs-cTnT) with NLR of 0.21.

Conclusion: None of the biomarker identifies a subgroup of patients who can be managed as an outpatient versus patients who may get benefit from thrombolytics with certainty; however, H-FABP and hs-cTnT showed some promising results and should be investigated further.

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References

Kang D, Sun J, Park K, Lim H . Usefulness of combined assessment with computed tomographic signs of right ventricular dysfunction and cardiac troponin T for risk stratification of acute pulmonary embolism. Am J Cardiol. 2011; 108(1):133-40. DOI: 10.1016/j.amjcard.2011.03.009. View

Kostrubiec M, Pruszczyk P, Bochowicz A, Pacho R, Szulc M, Kaczynska A . Biomarker-based risk assessment model in acute pulmonary embolism. Eur Heart J. 2005; 26(20):2166-72. DOI: 10.1093/eurheartj/ehi336. View

Singanayagam A, Scally C, Al-Khairalla M, Leitch L, HILL L, Chalmers J . Are biomarkers additive to pulmonary embolism severity index for severity assessment in normotensive patients with acute pulmonary embolism?. QJM. 2010; 104(2):125-31. DOI: 10.1093/qjmed/hcq168. View

Grimes D, Schulz K . Refining clinical diagnosis with likelihood ratios. Lancet. 2005; 365(9469):1500-5. DOI: 10.1016/S0140-6736(05)66422-7. View

Herbison P, Hay-Smith J, Gillespie W . Adjustment of meta-analyses on the basis of quality scores should be abandoned. J Clin Epidemiol. 2006; 59(12):1249-56. DOI: 10.1016/j.jclinepi.2006.03.008. View

Bova C, Crocco F, Ricchio R, Serafini O, Greco F, Noto A . Importance of troponin T for the risk stratification of normotensive patients with pulmonary embolism. A prospective, cohort study with a three-month follow-up. Haematologica. 2005; 90(3):423-4. View

Aujesky D, Smith K, Cornuz J, Roberts M . Cost-effectiveness of low-molecular-weight heparin for treatment of pulmonary embolism. Chest. 2005; 128(3):1601-10. DOI: 10.1378/chest.128.3.1601. View

Maziere F, Birolleau S, Medimagh S, Arthaud M, Bennaceur M, Riou B . Comparison of troponin I and N-terminal-pro B-type natriuretic peptide for risk stratification in patients with pulmonary embolism. Eur J Emerg Med. 2007; 14(4):207-11. DOI: 10.1097/MEJ.0b013e3280bef891. View

Logeart D, Lecuyer L, Thabut G, Tabet J, Tartiere J, Chavelas C . Biomarker-based strategy for screening right ventricular dysfunction in patients with non-massive pulmonary embolism. Intensive Care Med. 2006; 33(2):286-92. DOI: 10.1007/s00134-006-0482-1. View

10.

Tulevski I, ten Wolde M, Van Veldhuisen D, Mulder J, van der Wall E, Buller H . Combined utility of brain natriuretic peptide and cardiac troponin T may improve rapid triage and risk stratification in normotensive patients with pulmonary embolism. Int J Cardiol. 2006; 116(2):161-6. DOI: 10.1016/j.ijcard.2006.03.030. View

11.

Goldhaber S, Bounameaux H . Pulmonary embolism and deep vein thrombosis. Lancet. 2012; 379(9828):1835-46. DOI: 10.1016/S0140-6736(11)61904-1. View

12.

Gul E, Can I, Guler I, Yesildag A, Abdulhalikov T, Kayrak M . Association of pulmonary artery obstruction index with elevated heart-type fatty acid binding protein and short-term mortality in patients with pulmonary embolism at intermediate risk. Diagn Interv Radiol. 2012; 18(6):531-6. DOI: 10.4261/1305-3825.DIR.5827-12.3. View

13.

MOSES L, Shapiro D, Littenberg B . Combining independent studies of a diagnostic test into a summary ROC curve: data-analytic approaches and some additional considerations. Stat Med. 1993; 12(14):1293-316. DOI: 10.1002/sim.4780121403. View

14.

Vuilleumier N, Le Gal G, Verschuren F, Perrier A, Bounameaux H, Turck N . Cardiac biomarkers for risk stratification in non-massive pulmonary embolism: a multicenter prospective study. J Thromb Haemost. 2008; 7(3):391-8. DOI: 10.1111/j.1538-7836.2008.03260.x. View

15.

Lankeit M, Jimenez D, Kostrubiec M, Dellas C, Kuhnert K, Hasenfuss G . Validation of N-terminal pro-brain natriuretic peptide cut-off values for risk stratification of pulmonary embolism. Eur Respir J. 2014; 43(6):1669-77. DOI: 10.1183/09031936.00211613. View

16.

Boscheri A, Wunderlich C, Langer M, Schoen S, Wiedemann B, Stolte D . Correlation of heart-type fatty acid-binding protein with mortality and echocardiographic data in patients with pulmonary embolism at intermediate risk. Am Heart J. 2010; 160(2):294-300. DOI: 10.1016/j.ahj.2010.05.010. View

17.

Palmieri V, Gallotta G, Rendina D, De Bonis S, Russo V, Postiglione A . Troponin I and right ventricular dysfunction for risk assessment in patients with nonmassive pulmonary embolism in the Emergency Department in combination with clinically based risk score. Intern Emerg Med. 2008; 3(2):131-8. DOI: 10.1007/s11739-008-0134-2. View

18.

Pieralli F, Olivotto I, Vanni S, Conti A, Camaiti A, Targioni G . Usefulness of bedside testing for brain natriuretic peptide to identify right ventricular dysfunction and outcome in normotensive patients with acute pulmonary embolism. Am J Cardiol. 2006; 97(9):1386-90. DOI: 10.1016/j.amjcard.2005.11.075. View

19.

Becattini C, Casazza F, Forgione C, Porro F, Fadin B, Stucchi A . Acute pulmonary embolism: external validation of an integrated risk stratification model. Chest. 2013; 144(5):1539-1545. DOI: 10.1378/chest.12-2938. View

20.

Klok F, van der Bijl N, Eikenboom H, van Rooden C, de Roos A, Kroft L . Comparison of CT assessed right ventricular size and cardiac biomarkers for predicting short-term clinical outcome in normotensive patients suspected of having acute pulmonary embolism. J Thromb Haemost. 2010; 8(4):853-6. DOI: 10.1111/j.1538-7836.2010.03780.x. View