Juha Kauppi, K E Juhani Airaksinen, Joonas Lehto, Jussi-Pekka Pouru, Juuso Saha, Petra Purola, Samuli Jaakkola, Jarmo Lehtonen, Tuija Vasankari, Markus Juonala, Tuomas Kiviniemi
{"title":"D-二聚体、心肌肌钙蛋白 T、C 反应蛋白和 NT-proBNP在预测疑似肺栓塞患者长期死亡率方面的表现。","authors":"Juha Kauppi, K E Juhani Airaksinen, Joonas Lehto, Jussi-Pekka Pouru, Juuso Saha, Petra Purola, Samuli Jaakkola, Jarmo Lehtonen, Tuija Vasankari, Markus Juonala, Tuomas Kiviniemi","doi":"10.1093/ehjopen/oeae079","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>Pulmonary embolism (PE) is a common and potentially life-threatening condition requiring emergent diagnostic work-up. Despite wide use of biomarkers, little is known how they predict long-term prognosis of patients evaluated for suspected PE.</p><p><strong>Methods and results: </strong>We sought to assess the predictive performance of N-terminal pro-brain natriuretic peptide (NT-proBNP), C-reactive protein, fibrin D-dimer (FIDD), and cardiac troponin T (cTnT) in patients who underwent computed tomography pulmonary angiography (CTPA) for clinical suspicion of PE. The analysis involved 1001 patients, with 222 (22.2%) receiving a PE diagnosis at index imaging. Mean ages of patients with and without PE were 65.0 ± 17.1 and 64.5 ± 17.7 years, respectively. Median follow-up time was 3.9 years (interquartile range 2.9-4.9). Mortality was relatively high among both patients with and without documented PE (24.8% vs. 31.7%, <i>P</i> = 0.047). In patients with PE, only elevated NT-proBNP > 1000 ng/L and C-reactive protein > 50 mg/L levels at hospital admission were associated with higher mortality in an adjusted Cox regression model, but receiver operating characteristic (ROC) analysis showed no improved prediction compared to clinical variables. Among patients without PE, elevated NT-proBNP > 1000 ng/L, C-reactive protein > 10 mg/L, cTnT > 50 ng/L, and FIDD > 1.0 mg/L all predicted mortality. In an ROC analysis among patients without PE, models including NT-proBNP, cTnT, or C-reactive protein provided improved predictive performance.</p><p><strong>Conclusion: </strong>Patients evaluated for clinical suspicion of PE have high long-term mortality. Commonly used biomarkers provide long-term prognostic value in patients without PE. Given the relatively young age, it is vital to identify these high-risk patients and perform differential diagnosis work-up for alternative life-threatening conditions, and manage them as appropriate.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 5","pages":"oeae079"},"PeriodicalIF":0.0000,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467688/pdf/","citationCount":"0","resultStr":"{\"title\":\"Performance of D-dimer, cardiac troponin T, C-reactive protein, and NT-proBNP in prediction of long-term mortality in patients with suspected pulmonary embolism.\",\"authors\":\"Juha Kauppi, K E Juhani Airaksinen, Joonas Lehto, Jussi-Pekka Pouru, Juuso Saha, Petra Purola, Samuli Jaakkola, Jarmo Lehtonen, Tuija Vasankari, Markus Juonala, Tuomas Kiviniemi\",\"doi\":\"10.1093/ehjopen/oeae079\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>Pulmonary embolism (PE) is a common and potentially life-threatening condition requiring emergent diagnostic work-up. Despite wide use of biomarkers, little is known how they predict long-term prognosis of patients evaluated for suspected PE.</p><p><strong>Methods and results: </strong>We sought to assess the predictive performance of N-terminal pro-brain natriuretic peptide (NT-proBNP), C-reactive protein, fibrin D-dimer (FIDD), and cardiac troponin T (cTnT) in patients who underwent computed tomography pulmonary angiography (CTPA) for clinical suspicion of PE. The analysis involved 1001 patients, with 222 (22.2%) receiving a PE diagnosis at index imaging. Mean ages of patients with and without PE were 65.0 ± 17.1 and 64.5 ± 17.7 years, respectively. Median follow-up time was 3.9 years (interquartile range 2.9-4.9). Mortality was relatively high among both patients with and without documented PE (24.8% vs. 31.7%, <i>P</i> = 0.047). In patients with PE, only elevated NT-proBNP > 1000 ng/L and C-reactive protein > 50 mg/L levels at hospital admission were associated with higher mortality in an adjusted Cox regression model, but receiver operating characteristic (ROC) analysis showed no improved prediction compared to clinical variables. Among patients without PE, elevated NT-proBNP > 1000 ng/L, C-reactive protein > 10 mg/L, cTnT > 50 ng/L, and FIDD > 1.0 mg/L all predicted mortality. In an ROC analysis among patients without PE, models including NT-proBNP, cTnT, or C-reactive protein provided improved predictive performance.</p><p><strong>Conclusion: </strong>Patients evaluated for clinical suspicion of PE have high long-term mortality. Commonly used biomarkers provide long-term prognostic value in patients without PE. Given the relatively young age, it is vital to identify these high-risk patients and perform differential diagnosis work-up for alternative life-threatening conditions, and manage them as appropriate.</p>\",\"PeriodicalId\":93995,\"journal\":{\"name\":\"European heart journal open\",\"volume\":\"4 5\",\"pages\":\"oeae079\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-09-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467688/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European heart journal open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1093/ehjopen/oeae079\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/9/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European heart journal open","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1093/ehjopen/oeae079","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/9/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
目的：肺栓塞（PE）是一种常见且可能危及生命的疾病，需要进行紧急诊断。尽管生物标志物被广泛使用，但人们对其如何预测疑似肺栓塞患者的长期预后知之甚少：我们试图评估 N 端前脑钠肽 (NT-proBNP)、C 反应蛋白、纤维蛋白 D-二聚体 (FIDD) 和心肌肌钙蛋白 T (cTnT) 对因临床怀疑 PE 而接受计算机断层扫描肺血管造影术 (CTPA) 患者的预测能力。该分析涉及 1001 名患者，其中 222 人（22.2%）在指数成像时得到 PE 诊断。有 PE 和无 PE 患者的平均年龄分别为 65.0 ± 17.1 岁和 64.5 ± 17.7 岁。中位随访时间为 3.9 年（四分位间范围为 2.9-4.9）。有记录和无记录 PE 患者的死亡率都相对较高（24.8% vs. 31.7%，P = 0.047）。在 PE 患者中，在调整后的 Cox 回归模型中，只有入院时升高的 NT-proBNP > 1000 ng/L 和 C 反应蛋白 > 50 mg/L 水平与较高的死亡率相关，但接受者操作特征（ROC）分析显示，与临床变量相比，预测效果并无改善。在无 PE 的患者中，NT-proBNP 升高 > 1000 ng/L、C 反应蛋白 > 10 mg/L、cTnT > 50 ng/L 和 FIDD > 1.0 mg/L 均可预测死亡率。在对无 PE 患者进行的 ROC 分析中，包括 NT-proBNP、cTnT 或 C 反应蛋白在内的模型可提高预测性能：结论：因临床怀疑 PE 而接受评估的患者长期死亡率很高。结论：因临床怀疑 PE 而接受评估的患者的长期死亡率很高。常用的生物标志物对无 PE 的患者具有长期预后价值。鉴于这些患者年龄相对较小，因此必须识别这些高危患者，对其他危及生命的疾病进行鉴别诊断，并酌情处理。
Performance of D-dimer, cardiac troponin T, C-reactive protein, and NT-proBNP in prediction of long-term mortality in patients with suspected pulmonary embolism.
Aims: Pulmonary embolism (PE) is a common and potentially life-threatening condition requiring emergent diagnostic work-up. Despite wide use of biomarkers, little is known how they predict long-term prognosis of patients evaluated for suspected PE.
Methods and results: We sought to assess the predictive performance of N-terminal pro-brain natriuretic peptide (NT-proBNP), C-reactive protein, fibrin D-dimer (FIDD), and cardiac troponin T (cTnT) in patients who underwent computed tomography pulmonary angiography (CTPA) for clinical suspicion of PE. The analysis involved 1001 patients, with 222 (22.2%) receiving a PE diagnosis at index imaging. Mean ages of patients with and without PE were 65.0 ± 17.1 and 64.5 ± 17.7 years, respectively. Median follow-up time was 3.9 years (interquartile range 2.9-4.9). Mortality was relatively high among both patients with and without documented PE (24.8% vs. 31.7%, P = 0.047). In patients with PE, only elevated NT-proBNP > 1000 ng/L and C-reactive protein > 50 mg/L levels at hospital admission were associated with higher mortality in an adjusted Cox regression model, but receiver operating characteristic (ROC) analysis showed no improved prediction compared to clinical variables. Among patients without PE, elevated NT-proBNP > 1000 ng/L, C-reactive protein > 10 mg/L, cTnT > 50 ng/L, and FIDD > 1.0 mg/L all predicted mortality. In an ROC analysis among patients without PE, models including NT-proBNP, cTnT, or C-reactive protein provided improved predictive performance.
Conclusion: Patients evaluated for clinical suspicion of PE have high long-term mortality. Commonly used biomarkers provide long-term prognostic value in patients without PE. Given the relatively young age, it is vital to identify these high-risk patients and perform differential diagnosis work-up for alternative life-threatening conditions, and manage them as appropriate.
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