Ibrahim Muhammad, Ahmad Jawad, Abbas Muhammad, Umar Zeeshan, Nasir Momal, Zain Kabsha, Ahmad Jamil, Arshad Seemab, Bashir Atif, Ullah Sami, Ahmad Zubair, Safdar Sundas
Acute Internal Medicine (AIM), University Hospitals Birmingham NHS Foundation Trust, Birmingham, GBR.
Neurology, Lady Reading Hospital Peshawar, Peshawar, PAK.
Cureus. 2025 May 20;17(5):e84460. doi: 10.7759/cureus.84460. eCollection 2025 May.
This systematic review evaluates the diagnostic and prognostic utility of N-terminal pro-B-type natriuretic peptide (NT-proBNP), cardiac troponins, and D-dimer in acute cardio-respiratory syndromes, including heart failure (HF), acute coronary syndrome (ACS), pulmonary embolism (PE), acute respiratory distress syndrome (ARDS), and coronavirus disease 2019 (COVID-19)-related complications. These biomarkers play critical roles in assessing myocardial stress, injury, and thrombosis risk, offering a rapid and cost-effective alternative to traditional diagnostic tools. A comprehensive literature search from 2015 to 2024 identified 14 high-quality studies, demonstrating NT-proBNP's strong correlation with HF severity and mortality risk in severe COVID-19, while cardiac troponins were associated with myocardial injury in ARDS and ACS. D-dimer emerged as a predictor of thrombotic complications and poor outcomes in interstitial lung disease (ILD) and PE. The combined use of these biomarkers significantly improved risk stratification, enabling early intervention and reducing unnecessary imaging and invasive testing. A multi-marker approach provided superior predictive accuracy for mortality and recurrence risk in PE compared to single biomarker assessments. Despite some methodological limitations, including heterogeneity in biomarker thresholds, the findings support the integration of these markers into routine clinical practice to enhance early diagnosis and patient management. Future research should focus on standardizing biomarker cut-off values, conducting large-scale multi-center trials, and incorporating biomarker data into artificial intelligence (AI)-driven decision systems. This study highlights the potential of biomarker-driven risk assessment in cardio-respiratory medicine, paving the way for more precise, early, and effective intervention strategies to optimize patient outcomes and advance precision medicine in critical care settings.
本系统评价评估了N端前B型利钠肽（NT-proBNP）、心肌肌钙蛋白和D-二聚体在急性心肺综合征中的诊断和预后价值，这些综合征包括心力衰竭（HF）、急性冠状动脉综合征（ACS）、肺栓塞（PE）、急性呼吸窘迫综合征（ARDS）以及2019冠状病毒病（COVID-19）相关并发症。这些生物标志物在评估心肌应激、损伤和血栓形成风险方面发挥着关键作用，为传统诊断工具提供了一种快速且经济高效的替代方法。对2015年至2024年的文献进行全面检索后，确定了14项高质量研究，结果表明NT-proBNP与重症COVID-19患者的HF严重程度和死亡风险密切相关，而心肌肌钙蛋白与ARDS和ACS患者的心肌损伤有关。D-二聚体是间质性肺疾病（ILD）和PE患者血栓形成并发症及不良预后的预测指标。联合使用这些生物标志物可显著改善风险分层，实现早期干预并减少不必要的影像学检查和侵入性检测。与单一生物标志物评估相比，多标志物方法在预测PE患者的死亡率和复发风险方面具有更高的准确性。尽管存在一些方法学上的局限性，包括生物标志物阈值的异质性，但研究结果支持将这些标志物纳入常规临床实践，以加强早期诊断和患者管理。未来的研究应聚焦于标准化生物标志物的临界值、开展大规模多中心试验，并将生物标志物数据纳入人工智能（AI）驱动的决策系统。本研究凸显了生物标志物驱动的风险评估在心肺医学中的潜力，为制定更精确、早期和有效的干预策略铺平了道路，以优化患者预后并推动重症监护领域的精准医学发展。
