Alonso-Martínez José Luis, Annicchérico-Sánchez Francisco Javier, Urbieta-Echezarreta Miren Aránzazu, Pérez-Ricarte Sara
Department A of Internal Medicine, Hospital Complex of Navarra, Irunlarrea 6, 31008 Pamplona, Spain.
Department A of Internal Medicine, Hospital Complex of Navarra, Irunlarrea 6, 31008 Pamplona, Spain.
Med Clin (Barc). 2015 Mar 15;144(6):241-6. doi: 10.1016/j.medcli.2013.11.041. Epub 2014 Jun 16.
After an acute pulmonary embolism few long-term prognostic factors have shown to be of practical use. We hypothesized that, as in heart failure, natriuretic peptides could serve as biomarkers of a late deleterious prognosis.
Consecutive patients admitted to an Internal Medicine ward diagnosed with acute pulmonary embolism were traced through the computerized system of clinical episodes of Navarra Health System and by telephone calls. On hospitalization, standard evaluation was made, previous history of cancer and cardiac disease was recorded, and N-terminal ProB-type natriuretic peptide (NT-ProBNP), D-dimer and Troponin I were measured. In the analysis all-causes death was considered.
Two hundred and thirty-four patients were traced, median age 75 [interquartile range (IQR) 16] years old, women 51%. At a median time of 9.5 (IQR 29) months 52 (22%) patients had died, 38 (73%) dead patients had NT-ProBNP higher than 850 ng/L. NT-ProBNP in dead patients was 2.741 (IQR 7.420)ng/L and 662 (IQR 2.517)ng/L in survivors (p<0.001). Age (OR 4.37 CI 95% 1.04-1.16) and NT-ProBNP (OR 1.49 CI 95% 1-1.002) showed to be independent factors of mortality. Between the 3rd and 20th month after the diagnosis, a level of NT-ProBNP higher than 850 ng/L (sensitivity 0.86, specificity 0.45 and negative predictive value 0.92) was associated with a lower survival (p=0.019), hazard ratio 1.89, OR 7.67 (CI 95% 1.52-39.44) for this period.
Besides the unchangeable age, plasma level of NT-ProBNP measured on acute pulmonary embolism could predict longer-term all-cause death.
急性肺栓塞后，几乎没有长期预后因素显示具有实际应用价值。我们推测，与心力衰竭一样，利钠肽可作为不良远期预后的生物标志物。
通过纳瓦拉卫生系统临床事件计算机系统及电话随访，追踪内科病房收治的连续诊断为急性肺栓塞的患者。住院时进行标准评估，记录癌症和心脏病既往史，并检测N末端B型利钠肽原（NT-ProBNP）、D-二聚体和肌钙蛋白I。分析中考虑全因死亡情况。
共追踪到234例患者，中位年龄75[四分位间距（IQR）16]岁，女性占51%。在中位时间9.5（IQR 29）个月时，52例（22%）患者死亡，38例（73%）死亡患者的NT-ProBNP高于850 ng/L。死亡患者的NT-ProBNP为2.741（IQR 7.420）ng/L，存活患者为662（IQR 2.517）ng/L（p<0.001）。年龄（比值比4.37，95%置信区间1.04 - 1.16）和NT-ProBNP（比值比1.49，95%置信区间1 - 1.002）显示为死亡的独立因素。在诊断后的第3至20个月之间，NT-ProBNP水平高于850 ng/L（敏感性0.86，特异性0.45，阴性预测值0.92）与较低的生存率相关（p = 0.019），此期间风险比为1.89，比值比为7.67（95%置信区间1.52 - 39.44）。
除了不可改变的年龄外，急性肺栓塞时检测的血浆NT-ProBNP水平可预测长期全因死亡。
