The Prognostic Value of Troponin in Acute Pulmonary Embolism: A Systematic Review and Meta-Analysis.

Abstract

Acute pulmonary embolism (PE) is a major cause of cardiovascular morbidity and mortality. Troponin elevation is increasingly used for risk stratification, but its prognostic utility remains variably reported across studies. To evaluate the prognostic value of troponin elevation in patients with acute PE, concerning short-term mortality and adverse clinical outcomes. A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines. PubMed was searched from January 2000 to the present, using terms such as "pulmonary embolism," "troponin," and "prognosis." Eligible studies reported associations between troponin elevation and mortality or adverse events in adult patients with PE. Data were synthesised quantitatively and narratively. The Quality in Prognosis Studies (QUIPS) tool was used to assess risk of bias. Sixty studies (n = 25,282) were included. Meta-analysis showed that elevated troponin was significantly associated with increased in-hospital mortality (OR: 5.42; 95% CI: 4.35-6.83), 30-day mortality (OR: 4.35; 95% CI: 3.30-5.74), right ventricular dysfunction (OR: 3.42; 95% CI: 2.69-4.31), haemodynamic instability (OR: 3.29 95% CI: 2.48-4.39), and intensive care unit admission (OR: 5.81 95% CI: 3.52-9.68). Non-meta-analysed mortality data were similar to the meta-analysed data, showing an association between elevated troponin levels and worse outcomes in PE. These associations were observed across both conventional and high-sensitivity assays, as well as normotensive or low-risk patients. Elevated troponin is a strong and consistent predictor of short-term mortality and clinical deterioration in acute PE. With further research, it has the potential to be more widely integrated into risk stratification frameworks.