Plasma N-terminal pro-brain natriuretic peptide concentrations may help to identify patients with very low-risk acute pulmonary embolism: A preliminary study.

IF 2.1 4区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL
Bartosz Karolak, Marta Skowrońska, Michał Machowski, Olga Dzikowska-Diduch, Piotr Bienias, Martyna Kuryła, Małgorzata Wiśniewska, Marek Gołębiowski, Piotr Pruszczyk, Michał Ciurzyński
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引用次数: 0

Abstract

Background: Patients with an acute pulmonary embolism (APE) are a heterogeneous group, and some of them may benefit from early discharge and an ambulatory care referral. We aimed to evaluate the use of N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma level assessment in patients with low-risk APE based on clinical findings (0 points on the simplified Pulmonary Embolism Severity Index (sPESI)).

Material and methods: Preliminary analysis of an ongoing prospective study including 1,151 normotensive patients with at least a segmental APE. In the final analysis, 348 patients with a 0-point sPESI were included. Blood samples were collected within the first 24 h of admission. The clinical endpoint (CE) included APE-related mortality and/or rescue thrombolysis in patients with clinical deterioration.

Results: Clinical endpoints occurred in 3 patients who had higher plasma NT-proBNP levels than study participants with a favorable clinical course (164 [64-650] pg/mL compared to 2,930 [2,285.5-13,965] pg/mL; p = 0.01). Receiver operating characteristic (ROC) analysis showed that the area under the curve (AUC) for NT-proBNP for the prediction of the CEs was 0.918 (95% confidence interval [95% CI]: 0.831-1.00; p = 0.013). We defined the cutoff value of NT-proBNP at ≥1,641 pg/mL.

Conclusions: Among subjects with 0 points on the sPESI, those with concentrations of NT-proBNP exceeding 1,641 pg/mL might require closer attention; remaining patients could be considered candidates for outpatient treatment. However, these findings warrant further investigation in a large, prospective group of patients.

血浆中 N 端前脑钠肽的浓度可能有助于识别风险极低的急性肺栓塞患者:一项初步研究。
背景:急性肺栓塞(APE)患者是一个异质性群体,其中一些患者可能受益于早期出院和门诊转诊。我们旨在根据临床发现(简化肺栓塞严重程度指数(sPESI)为 0 分)评估 N 端脑钠肽血浆水平在低风险 APE 患者中的应用:对一项正在进行的前瞻性研究进行初步分析,该研究包括 1,151 名至少患有节段性 APE 的正常血压患者。最终分析纳入了 348 名 sPESI 为 0 分的患者。血液样本在入院后 24 小时内采集。临床终点(CE)包括 APE 相关死亡率和/或临床恶化患者的溶栓抢救:结果:3 名患者出现了临床终点,他们的血浆 NT-proBNP 水平高于临床过程良好的研究参与者(164 [64-650] pg/mL 与 2,930 [2,285.5-13,965] pg/mL; p = 0.01)。接收者操作特征(ROC)分析显示,NT-proBNP 预测 CEs 的曲线下面积(AUC)为 0.918(95% 置信区间 [95%CI]:0.831-1.00;p = 0.013)。我们将 NT-proBNP 的临界值定义为≥1,641 pg/mL:在 sPESI 为 0 分的受试者中,NT-proBNP 浓度超过 1,641 pg/mL 的患者可能需要更密切的关注;其余患者可考虑接受门诊治疗。然而,这些发现需要在一个大型、前瞻性的患者群体中进行进一步研究。
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来源期刊
Advances in Clinical and Experimental Medicine
Advances in Clinical and Experimental Medicine MEDICINE, RESEARCH & EXPERIMENTAL-
CiteScore
3.70
自引率
4.80%
发文量
153
审稿时长
6-12 weeks
期刊介绍: Advances in Clinical and Experimental Medicine has been published by the Wroclaw Medical University since 1992. Establishing the medical journal was the idea of Prof. Bogumił Halawa, Chair of the Department of Cardiology, and was fully supported by the Rector of Wroclaw Medical University, Prof. Zbigniew Knapik. Prof. Halawa was also the first editor-in-chief, between 1992-1997. The journal, then entitled "Postępy Medycyny Klinicznej i Doświadczalnej", appeared quarterly. Prof. Leszek Paradowski was editor-in-chief from 1997-1999. In 1998 he initiated alterations in the profile and cover design of the journal which were accepted by the Editorial Board. The title was changed to Advances in Clinical and Experimental Medicine. Articles in English were welcomed. A number of outstanding representatives of medical science from Poland and abroad were invited to participate in the newly established International Editorial Staff. Prof. Antonina Harłozińska-Szmyrka was editor-in-chief in years 2000-2005, in years 2006-2007 once again prof. Leszek Paradowski and prof. Maria Podolak-Dawidziak was editor-in-chief in years 2008-2016. Since 2017 the editor-in chief is prof. Maciej Bagłaj. Since July 2005, original papers have been published only in English. Case reports are no longer accepted. The manuscripts are reviewed by two independent reviewers and a statistical reviewer, and English texts are proofread by a native speaker. The journal has been indexed in several databases: Scopus, Ulrich’sTM International Periodicals Directory, Index Copernicus and since 2007 in Thomson Reuters databases: Science Citation Index Expanded i Journal Citation Reports/Science Edition. In 2010 the journal obtained Impact Factor which is now 1.179 pts. Articles published in the journal are worth 15 points among Polish journals according to the Polish Committee for Scientific Research and 169.43 points according to the Index Copernicus. Since November 7, 2012, Advances in Clinical and Experimental Medicine has been indexed and included in National Library of Medicine’s MEDLINE database. English abstracts printed in the journal are included and searchable using PubMed http://www.ncbi.nlm.nih.gov/pubmed.
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