B 型利钠肽在预测肺栓塞患者早期死亡率中的意义，联合肌钙蛋白：一项多中心注册研究的见解。
The significance of B-type natriuretic peptide in predicting early mortality among pulmonary embolism patients, alongside troponin: insights from a multicentric registry.
机构信息
Clinic of Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia; School of Medicine, University of Defense, Belgrade, Serbia.
Jacobi/North Central Bronx Hospital, New York, NY, USA.
出版信息
Curr Probl Cardiol. 2024 Apr;49(4):102437. doi: 10.1016/j.cpcardiol.2024.102437. Epub 2024 Feb 1.
BACKGROUND
Early mortality assessment in acute pulmonary embolism (PE) is crucial for treatment decisions. The role of natriuretic peptides in this context is debated. This study explores elevated B-type natriuretic peptide (BNP) levels, relative to the upper normal limit (UNL), predicting mortality in PE, comparing with troponin (Tn).
METHODOLOGY
A multicenter PE registry analyzed predictive values for early mortality risk using BNP and Tn, based on proportional elevation to the UNL. Patients followed current PE guidelines.
RESULTS
Among 1677 PE patients, BNP's AUC exceeded Tn for all-cause (0.727 vs. 0.614) and PE-related mortality (0.785 vs. 0.644), though nonsignificant. BNP's cutoff was 3.5 times UNL for both all-cause and PE-related mortalities; Tn cutoffs were 1.38 and 1.23 times UNL, respectively.
CONCLUSION
Elevated BNP relative to UNL significantly predicts all-cause and PE-related mortality. While akin to Tn, BNP merits consideration in assessing acute PE risk, especially in intermediate-high-risk cases.
背景
急性肺栓塞（PE）的早期死亡率评估对于治疗决策至关重要。在这种情况下，利钠肽的作用存在争议。本研究探讨了与肌钙蛋白（Tn）相比，B 型利钠肽（BNP）水平相对于上限正常范围（UNL）升高对 PE 死亡率的预测作用。
方法
一个多中心的 PE 登记处基于与 UNL 的比例升高，使用 BNP 和 Tn 分析了早期死亡率风险的预测值。患者遵循当前的 PE 指南。
结果
在 1677 例 PE 患者中，BNP 在全因（0.727 对 0.614）和与 PE 相关的死亡率（0.785 对 0.644）方面的 AUC 均超过 Tn，但无统计学意义。BNP 的全因和与 PE 相关死亡率的截断值均为 UNL 的 3.5 倍；Tn 的截断值分别为 UNL 的 1.38 倍和 1.23 倍。
结论
与 UNL 相比，升高的 BNP 显著预测全因和与 PE 相关的死亡率。虽然与 Tn 类似，但 BNP 在评估急性 PE 风险时值得考虑，尤其是在中高危病例中。
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