Department of Respiratory and Critical Care Medicine, Kailuan General Hospital, 57 East Xinhua Rd, Tangshan, Hebei, China.
Hospital Infection Management Division, Kailuan General Hospital, 57 East Xinhua Rd, Tangshan, Hebei, China.
Sci Rep. 2021 Jul 21;11(1):14909. doi: 10.1038/s41598-021-94346-7.
Previous studies on the adverse events of acute pulmonary embolism (APE) were mostly limited to single marker, and short follow-up duration, from hospitalization to up to 30 days. We aimed to predict the long-term prognosis of patients with APE by joint assessment of D-dimer, N-Terminal Pro-Brain Natriuretic Peptide (NT-ProBNP), and troponin I (cTnI). Newly diagnosed patients of APE from January 2011 to December 2015 were recruited from three hospitals. Medical information of the patients was collected retrospectively by reviewing medical records. Adverse events (APE recurrence and all-cause mortality) of all enrolled patients were followed up via telephone. D-dimer > 0.50 mg/L, NT-ProBNP > 500 pg/mL, and cTnI > 0.40 ng/mL were defined as the abnormal. Kaplan-Meier curve was used to compare the cumulative survival rate between patients with different numbers of abnormal markers. Cox proportional hazard regression model was used to further test the association between numbers of abnormal markers and long-term prognosis of patients with APE after adjusting for potential confounding. During follow-up, APE recurrence and all-cause mortality happened in 78 (30.1%) patients. The proportion of APE recurrence and death in one abnormal marker, two abnormal markers, and three abnormal markers groups were 7.69%, 28.21%, and 64.10% respectively. Patients with three abnormal markers had the lowest survival rate than those with one or two abnormal markers (Log-rank test, P < 0.001). After adjustment, patients with two or three abnormal markers had a significantly higher risk of the total adverse event compared to those with one abnormal marker. The hazard ratios (95% confidence interval) were 6.27 (3.24, 12.12) and 10.7 (4.1, 28.0), respectively. Separate analyses for APE recurrence and all-cause death found similar results. A joint test of abnormal D-dimer, NT-ProBNP, and cTnI in APE patients could better predict the long-term risk of APE recurrence and all-cause mortality.
先前关于急性肺栓塞（APE）不良事件的研究大多局限于单一标志物，且随访时间较短，从住院到 30 天内。我们旨在通过联合评估 D-二聚体、N 末端脑利钠肽前体（NT-ProBNP）和肌钙蛋白 I（cTnI）来预测 APE 患者的长期预后。从 2011 年 1 月至 2015 年 12 月，我们从三家医院招募了新诊断的 APE 患者。通过回顾病历，收集患者的医疗信息。通过电话对所有入组患者的不良事件（APE 复发和全因死亡率）进行随访。D-二聚体>0.50mg/L、NT-ProBNP>500pg/mL 和 cTnI>0.40ng/mL 定义为异常。Kaplan-Meier 曲线用于比较不同异常标志物数量的患者的累积生存率。Cox 比例风险回归模型用于进一步测试在调整潜在混杂因素后，异常标志物数量与 APE 患者长期预后之间的关系。在随访期间，78 例（30.1%）患者发生 APE 复发和全因死亡。一个异常标志物、两个异常标志物和三个异常标志物组的 APE 复发和死亡比例分别为 7.69%、28.21%和 64.10%。三个异常标志物的患者的生存率低于一个或两个异常标志物的患者（Log-rank 检验，P<0.001）。调整后，两个或三个异常标志物的患者发生总不良事件的风险明显高于一个异常标志物的患者。风险比（95%置信区间）分别为 6.27（3.24，12.12）和 10.7（4.1，28.0）。APE 复发和全因死亡的单独分析得到了类似的结果。联合检测 APE 患者异常 D-二聚体、NT-ProBNP 和 cTnI 可以更好地预测 APE 复发和全因死亡率的长期风险。
