Kauppi Juha, Airaksinen K E Juhani, Lehto Joonas, Pouru Jussi-Pekka, Saha Juuso, Purola Petra, Jaakkola Samuli, Lehtonen Jarmo, Vasankari Tuija, Juonala Markus, Kiviniemi Tuomas
Emergency Clinic, Turku University Hospital, Savitehtaankatu 1, 20540 Turku, Finland.
Heart Centre, Turku University Hospital, PL 52, FI-20521 Turku, Finland.
Eur Heart J Open. 2024 Sep 20;4(5):oeae079. doi: 10.1093/ehjopen/oeae079. eCollection 2024 Sep.
Pulmonary embolism (PE) is a common and potentially life-threatening condition requiring emergent diagnostic work-up. Despite wide use of biomarkers, little is known how they predict long-term prognosis of patients evaluated for suspected PE.
We sought to assess the predictive performance of N-terminal pro-brain natriuretic peptide (NT-proBNP), C-reactive protein, fibrin D-dimer (FIDD), and cardiac troponin T (cTnT) in patients who underwent computed tomography pulmonary angiography (CTPA) for clinical suspicion of PE. The analysis involved 1001 patients, with 222 (22.2%) receiving a PE diagnosis at index imaging. Mean ages of patients with and without PE were 65.0 ± 17.1 and 64.5 ± 17.7 years, respectively. Median follow-up time was 3.9 years (interquartile range 2.9-4.9). Mortality was relatively high among both patients with and without documented PE (24.8% vs. 31.7%, = 0.047). In patients with PE, only elevated NT-proBNP > 1000 ng/L and C-reactive protein > 50 mg/L levels at hospital admission were associated with higher mortality in an adjusted Cox regression model, but receiver operating characteristic (ROC) analysis showed no improved prediction compared to clinical variables. Among patients without PE, elevated NT-proBNP > 1000 ng/L, C-reactive protein > 10 mg/L, cTnT > 50 ng/L, and FIDD > 1.0 mg/L all predicted mortality. In an ROC analysis among patients without PE, models including NT-proBNP, cTnT, or C-reactive protein provided improved predictive performance.
Patients evaluated for clinical suspicion of PE have high long-term mortality. Commonly used biomarkers provide long-term prognostic value in patients without PE. Given the relatively young age, it is vital to identify these high-risk patients and perform differential diagnosis work-up for alternative life-threatening conditions, and manage them as appropriate.
肺栓塞（PE）是一种常见且可能危及生命的疾病，需要紧急进行诊断检查。尽管生物标志物被广泛应用，但对于它们如何预测疑似PE患者的长期预后知之甚少。
我们试图评估N末端脑钠肽前体（NT-proBNP）、C反应蛋白、纤维蛋白D-二聚体（FIDD）和心肌肌钙蛋白T（cTnT）在因临床怀疑PE而接受计算机断层扫描肺动脉造影（CTPA）的患者中的预测性能。该分析涉及1001例患者，其中222例（22.2%）在首次成像时被诊断为PE。有PE和无PE患者的平均年龄分别为65.0±17.1岁和64.5±17.7岁。中位随访时间为3.9年（四分位间距2.9 - 4.9）。有和无PE记录的患者死亡率都相对较高（24.8%对31.7%，P = 0.047）。在PE患者中，在调整后的Cox回归模型中，仅入院时NT-proBNP>1000 ng/L和C反应蛋白>50 mg/L水平升高与较高死亡率相关，但受试者工作特征（ROC）分析显示与临床变量相比预测并无改善。在无PE患者中，NT-proBNP>1000 ng/L、C反应蛋白>10 mg/L、cTnT>50 ng/L和FIDD>1.0 mg/L均预测死亡率。在无PE患者的ROC分析中，包括NT-proBNP、cTnT或C反应蛋白的模型具有更好的预测性能。
因临床怀疑PE而接受评估的患者长期死亡率较高。常用生物标志物对无PE患者具有长期预后价值。鉴于患者相对年轻，识别这些高危患者并对其他危及生命的疾病进行鉴别诊断检查并进行适当管理至关重要。
