Heart-type fatty acid-binding protein and myocardial creatine kinase enable rapid risk stratification in normotensive patients with pulmonary embolism

• Published in: Journal of critical care 2016-10, Vol.35, p.174-179
• Main Authors: Langer, Martin, Forkmann, Mathias, Richter, Utz, Tausche, Anne-Kathrin, Sveric, Krunoslav, Christoph, Marian, Ibrahim, Karim, Günther, Michael, Kolschmann, Steffen, Boscheri, Alessandra, Barthel, Peggy, Strasser, Ruth H, Wunderlich, Carsten
• Format: Article
• Language: English
• Subjects: Acute coronary syndromes; Aged; Aged, 80 and over; Biomarkers - blood; Blood Pressure - physiology; Confidence intervals; Creatine Kinase, MB Form - blood; Critical Care; Diabetes; Embolisms; Fatty Acid Binding Protein 3; Fatty Acid-Binding Proteins - blood; Female; H-FABP; Heart attacks; Heart rate; Hospital Mortality; Hospitals; Humans; Laboratories; Logistic Models; Male; Middle Aged; Mortality; Predictive Value of Tests; Prognosis; Prospective Studies; Proteins; Pulmonary embolism; Pulmonary Embolism - blood; Pulmonary Embolism - mortality; Pulmonary Embolism - physiopathology; Risk Assessment - methods; Risk stratification; Studies; Thrombosis; Troponin I - blood; Ventricular Dysfunction, Right - diagnosis; Ventricular Dysfunction, Right - mortality
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2016.05.014

Abstract Background Risk assessments of hemodynamically stable patients with pulmonary embolisms (PE) remain challenging. In this context hearttype fatty acid-binding protein (H-FABP), creatin kinase isoenzyme MB (CK-MB), and troponin I (TnI) may hold prognostic utility for patients with pulmonary embolism. Methods We included 161 consecutive normotensive (systolic blood pressure above 90 mm Hg) patients with confirmed PE to study the combined utility of echocardiographic signs of right ventricular dysfunction and several biomarkers (TnI, CK-MB, H-FABP). The primary endpoint was defined as death within 30 days after admission to the hospital. Results Elevated biomarkers were measured in 26 patients (16.1%) for HFABP, in 66 (41%) for TnI and in 41 (25.5%) for CK-MB. Echocardiography revealed right ventricular dysfunction (RVD) in 99 (61.5%) patients. Overall, 16 patients (9.9%) died within the study period. In the H-FABP positive group 15 (57.7%) patients died compared to 13 (19.7%) patients in the TnI positive group and 15 (37.5%) patients in the CK-MB positive group (H-FABP positive vs. TnI positive patients, p < 0.001; H-FABP positive vs. CK-MB positive patients p = 0.13; CK-MB positive vs. TnI positive patients p = 0.07). All elevated biomarkers correlated with the primary endpoint with H-FABP being strongly, CK-MB intermediately and TnI weakly associated with short term death (H-FABP r = 0.701, p < 0.001; CK-MB r = 0.486, p < 0.001; TnI r = 0.272, p = 0.001). In multivariate logistic regression analysis, a positive H-FABP test (OR 27.1, 95% CI 2.1 to 352.3, p = 0.001), elevated CK-MB levels (OR 5.3, 95% CI 1.3 to 23.3, p = 0.002) and a low systolic blood pressure on admission (OR 0.8, 95% CI 0.8 to 0.9, p < 0.001) emerged as independent predictors of 30-day mortality. Conclusions Both H-FABP and CK-MB are associated with short term mortality in normotensive PE patients and could be advantageous for risk stratification in this intermediate risk group.