Yu Haixu, Rong Wei, Yang Jie, Lu Jie, Ma Ke, Liu Zhuohui, Yuan Hui, Xu Lei, Li Yulin, Jing Zhi-Cheng, Du Jie
Beijing Anzhen Hospital of Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China.
Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing 100191, China.
J Clin Med. 2022 Jul 5;11(13):3908. doi: 10.3390/jcm11133908.
Tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) is associated with poor prognosis in cardiovascular diseases. However, the predictive value of TRAIL for the short-term outcome and risk stratification of acute pulmonary embolism (PE) remains unknown.
This study prospectively included 151 normotensive patients with acute PE. The study outcome was a composite of 30-day adverse events, defined as PE-related death, shock, mechanical ventilation, cardiopulmonary resuscitation, and major bleeding.
Overall, nine of 151 (6.0%) patients experienced 30-day adverse composite events. Multivariable logistic regression showed that TRAIL was an independent predictor of study outcome (OR 0.19 per SD; 95% CI 0.04-0.90). An ROC curve revealed that TRAIL's area under the curve (AUC) was 0.83 (95% CI 0.76-0.88). The optimal cut-off value for TRAIL was 18 pg/mL, with a sensitivity, specificity, negative predictive value, positive predictive value, positive likelihood ratio, and negative likelihood ratio of 89%, 69%, 99%, 15%, 2.87, and 0.16, respectively. Compared with the risk stratification algorithm outlined in the 2019 ESC guidelines, our biomarker-based risk stratification strategy (combining TRAIL and hs-cTnI) has a similar risk classification effect.
Reduced plasma TRAIL levels predict short-term adverse events in normotensive patients with acute PE. The combination of the 2019 ESC algorithm and TRAIL aids risk stratification in normotensive patients with acute PE.
肿瘤坏死因子（TNF）相关凋亡诱导配体（TRAIL）与心血管疾病的不良预后相关。然而，TRAIL对急性肺栓塞（PE）短期预后和风险分层的预测价值仍不清楚。
本研究前瞻性纳入了151例血压正常的急性PE患者。研究结局为30天不良事件的复合指标，定义为与PE相关的死亡、休克、机械通气、心肺复苏和大出血。
总体而言，151例患者中有9例（6.0%）发生了30天不良复合事件。多变量逻辑回归显示，TRAIL是研究结局的独立预测因子（每标准差的OR为0.19；95%CI为0.04-0.90）。ROC曲线显示，TRAIL的曲线下面积（AUC）为0.83（95%CI为0.76-0.88）。TRAIL的最佳截断值为18 pg/mL，其灵敏度、特异度、阴性预测值、阳性预测值、阳性似然比和阴性似然比分别为89%、69%、99%、15%、2.87和0.16。与2019年欧洲心脏病学会（ESC）指南中概述的风险分层算法相比，我们基于生物标志物的风险分层策略（结合TRAIL和高敏肌钙蛋白I）具有相似的风险分类效果。
血浆TRAIL水平降低可预测血压正常的急性PE患者的短期不良事件。2019年ESC算法与TRAIL相结合有助于血压正常的急性PE患者的风险分层。
