Elevated Biomarkers Predict Long-Term Mortality Risks in Patients with Suspected Pulmonary Embolism: Study
Finland: Recent research, published in the European Heart Journal Open has highlighted the critical role of several biomarkers-D-dimer, cardiac troponin T, C-reactive protein (CRP), and NT-proBNP-in predicting long-term mortality among patients evaluated for suspected pulmonary embolism (PE). The finding is particularly significant, as it highlights the high mortality risk faced by patients who present with clinical suspicion of PE, even when the diagnosis is ultimately ruled out.
The researchers observed high mortality rates both in patients with and without PE. They suggested that emergency departments give greater attention to these high-risk patients.
Patients with suspected PE often exhibit various symptoms, prompting clinicians to conduct thorough evaluations. However, the study revealed that many of these patients, particularly those who do not ultimately have PE, experience high long-term mortality rates. As such, identifying high-risk individuals early in their clinical journey is crucial.
Pulmonary embolism is a prevalent and potentially life-threatening condition that necessitates immediate diagnostic evaluation. While biomarkers are widely utilized in clinical settings, their role in predicting the long-term prognosis of patients assessed for suspected PE remains largely unclear. Considering this, Juha Kauppi, Turku University Hospital, Emergency Clinic, Turku, Finland, and colleagues sought to evaluate the predictive performance of NT-proBNP, C-reactive protein (CRP), D-dimer (FIDD), and cardiac troponin T (cTnT) in patients who underwent computed tomography pulmonary angiography (CTPA) due to clinical suspicion of PE.
The analysis included 1,001 patients, of whom 222 were diagnosed with pulmonary embolism at the time of imaging. The average age of patients with PE was 65.0 ± 17.1 years, compared to 64.5 ± 17.7 years for those without PE. The median follow-up duration was 3.9 years.
The study led to the following findings:
- Mortality was relatively high both among patients with and without documented PE (24.8% versus 31.7%).
- In patients with PE, only elevated NT-proBNP>1000 ng/L and CRP>50 mg/L levels at hospital admission were associated with higher mortality in an adjusted Cox regression model. Still, ROC analysis showed no improved prediction compared to clinical variables.
- Among patients without PE, elevated NT-proBNP>1000 ng/L, CRP>10 mg/L, cTnT>50 ng/L and FIDD>1.0 mg/L all predicted mortality.
- In a ROC analysis among patients without PE, models including NT-proBNP, cTnT, or CRP provided improved predictive performance.
The findings revealed that patients assessed for clinical suspicion of pulmonary embolism face significant long-term mortality risks. Commonly used biomarkers offer valuable prognostic information for those who do not have PE.
"Considering the relatively young age of many affected individuals, it is crucial to identify high-risk patients, conduct differential diagnoses for other potentially life-threatening conditions, and implement appropriate management strategies," the researchers concluded.
Reference:
Kauppi, J., Airaksinen, K. E., Lehto, J., Pouru, J., Saha, J., Purola, P., Jaakkola, S., Lehtonen, J., Vasankari, T., Juonala, M., & Kiviniemi, T. Performance of D-dimer, cardiac troponin T, C-reactive protein and NT-proBNP in prediction of long-term mortality in patients with suspected pulmonary embolism. European Heart Journal Open. https://doi.org/10.1093/ehjopen/oeae079
