Section of Clinical Biochemistry, University of Verona, Verona, Italy.
Department of Haematology, Sydney Centres for Thrombosis and Haemostasis, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, Australia.
Semin Thromb Hemost. 2019 Nov;45(8):784-792. doi: 10.1055/s-0039-1698762. Epub 2019 Oct 17.
The ability to predict death or other unfavorable outcomes after an acute pulmonary embolism (PE) is challenging, with current available risk score models having relatively unsatisfactory prognostic performance in this area. For example, the simplified pulmonary embolism severity index (sPESI), the most frequently used stratification tool, misclassifies a significant percentage of low- and high-risk patients. This gap in care, along with the increasing clinical availability of high-sensitivity cardiac troponin (hs-cTn) laboratory tests and the recent emphasis on detecting myocardial injury, may foster further evaluation of hs-cTn testing in patients with acute PE. Our analysis of the current scientific literature on hs-cTn in patients with acute PE identified that hs-cTn testing may provide valuable information for predicting future adverse outcomes and mortality, independently from baseline clinical risk assessment. Although the risk of an adverse event is indeed higher in patients with higher sPESI scores, cTns retain their prognostic value also in those at low risk, suggesting that a combination of hs-cTn with sPESI may provide an incremental value over assessment of either variable alone. Accordingly, the future development of updated risk stratification models, with the inclusion of laboratory tests such as hs-cTn, may represent an enhanced approach for risk stratification in patients with acute PE. Additional research, however, is needed to verify whether the combination of cTns, specifically as measured with hs-cTn assays, with other biomarkers may further improve the current capacity to efficiently manage patients with acute PE.
急性肺栓塞（PE）后预测死亡或其他不良结局的能力具有挑战性，目前可用的风险评分模型在这方面的预后性能相对不理想。例如，简化的肺栓塞严重指数（sPESI）是最常用的分层工具，它错误地分类了相当一部分低危和高危患者。这种护理差距，加上高敏心肌肌钙蛋白（hs-cTn）实验室检测的临床应用日益增加，以及最近对检测心肌损伤的重视，可能会进一步评估急性 PE 患者的 hs-cTn 检测。我们对急性 PE 患者 hs-cTn 的当前科学文献进行了分析，发现 hs-cTn 检测可能为预测未来不良结局和死亡率提供有价值的信息，与基线临床风险评估独立。尽管 sPESI 评分较高的患者发生不良事件的风险确实更高，但 cTn 在低危患者中也具有预后价值，这表明 hs-cTn 与 sPESI 的联合使用可能比单独评估任一变量提供更高的附加值。因此，未来开发更新的风险分层模型，包括 hs-cTn 等实验室检测，可能代表急性 PE 患者风险分层的一种增强方法。然而，需要进一步研究以验证 cTn，特别是通过 hs-cTn 检测测量的 cTn，与其他生物标志物的联合使用是否可以进一步提高目前有效管理急性 PE 患者的能力。
