UNIGE document Scientific Article
previous document  unige:20164  next document
add to browser collection
Title

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

Authors
Le Gal, G.
Verschuren, F.
show hidden authors show all authors [1 - 11]
Published in Journal of Thrombosis and Haemostasis. 2009, vol. 7, no. 3, p. 391-398
Abstract 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.
Keywords AdolescentAdultBiological MarkersFatty Acid-Binding Proteins/bloodFemaleFibrin Fibrinogen Degradation Products/analysisHumansMiddle AgedNatriuretic Peptide, Brain/bloodOdds RatioPeptide Fragments/blood*Predictive Value of TestsPrognosisProspective StudiesPulmonary Embolism/*diagnosisRisk AssessmentTroponin/bloodYoung Adult
Identifiers
PMID: 19087222
Full text
Structures
Research groups Epidémiologie clinique (115)
Geneva Platelet Group (13)
La protéomique au service de la clinique (270)
Groupe Perrier Arnaud (Médecine interne générale, de réhabilitation et de gériatrie) (585)
Groupe de Protéomique biomédicale (635)
La maladie thromboembolique veineuse (808)
Citation
(ISO format)
VUILLEUMIER, Nicolas et al. Cardiac biomarkers for risk stratification in non-massive pulmonary embolism: a multicenter prospective study. In: Journal of Thrombosis and Haemostasis, 2009, vol. 7, n° 3, p. 391-398. https://archive-ouverte.unige.ch/unige:20164

262 hits

1 download

Update

Deposited on : 2012-04-23

Export document
Format :
Citation style :