Biomarker-based risk assessment model in acute pulmonary embolism

Aims Despite growing interest in biomarkers application for risk evaluation in acute pulmonary embolism (APE), no decision-making levels have been defined. Methods and results We developed a biomarker-based risk stratification in 100 consecutive, normotensive on admission, APE patients (35 males, 65 females, 62 +/- 18 years). On admission serum NT-proBNP and cardiac troponin T (cTnT) levels were assessed and echocardiography was performed. All-cause 40-day mortality was 15% and APE mortality was 8%. In univariable analysis, cTnT > 0.07 mu g/L predicted all-cause mortality, hazard ratio (HR) 9.2 (95% CI: 3.3-26.1, P < 0.0001), and APE mortality, HR 18.1 (95% CI: 3.6-90.2, P=0.0004); similarly, NT-proBNP > 7600 ng/L predicted all-cause and APE mortalities [HR 6.7 (95% CI: 2.4-19.0, P=0.0003) and 7.3 (95% CI: 1.7-30.6, P=0.007)]. NT-proBNP < 600 ng/L indicated uncomplicated outcome. Multivariable analysis revealed that cTnT > 0.07 mu g/L was the most significant independent predictor, whereas NT-proBNP and systemic systolic blood pressure measured on admission and echocardiographic parameters were non-significant. APE mortality in patients with NT-proBNP >= 600 ng/L and cTnT >= 0.07 mu g/L reached 33%. NT-proBNP < 600 ng/L indicated group without deaths. APE mortality for patients with NT-proBNP >= 600 ng/L and cTnT < 0.07 mu g/L was 3.7%. Incorporation of echocardiographic data did not improve group selection. Conclusion Simultaneous measurement of serum cTnT and NT-proBNP allows for precise APE prognosis. Normotensive patients on admission with cTnT >= 0.07 mu g/L and NT-proBNP >= 600 ng/L are at high risk of APE mortality, whereas NTproBNP < 600 ng/L indicates excellent prognosis.