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

• Published in: Lung 2015-10, Vol.193 (5), p.639-651
• Main Authors: Bajaj, Anurag, Rathor, Parul, Sehgal, Vishal, Kabak, Besher, Shetty, Ajay, Al Masalmeh, Ossama, Hosur, Srikanth
• Format: Article
• Language: English
• Subjects: Acute Disease; Biological markers; Biomarkers; Biomarkers - blood; Care and treatment; Cause of Death; Development and progression; Diagnosis; Embolisms; Fatty Acid Binding Protein 3; Fatty Acid-Binding Proteins - blood; Fibrinolytic agents; Humans; Medicine; Medicine & Public Health; Meta-analysis; Natriuretic Peptide, Brain - blood; Patient outcomes; Peptide Fragments - blood; Pneumology/Respiratory System; Predictive Value of Tests; Prognosis; Pulmonary arteries; Pulmonary embolism; Pulmonary Embolism - blood; Pulmonary Embolism - mortality; Troponin - blood
• ISSN: 0341-2040; 1432-1750
• DOI: 10.1007/s00408-015-9752-4

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.