Risk stratification of elderly patients with acute pulmonary embolism.

Acute Disease Aged Aged, 80 and over C-Reactive Protein / metabolism Cohort Studies Female Humans Male Mortality Natriuretic Peptide, Brain / metabolism Peptide Fragments / metabolism Predictive Value of Tests Prognosis Proportional Hazards Models Prospective Studies Pulmonary Embolism / metabolism Risk Assessment Troponin T / metabolism

biomarkers elderly mortality pulmonary embolism risk stratification

Journal

European journal of clinical investigation

ISSN: 1365-2362

Titre abrégé: Eur J Clin Invest

Pays: England

ID NLM: 0245331

Informations de publication

Date de publication:
Sep 2019

Historique:

received: 29 01 2019

revised: 24 04 2019

accepted: 25 06 2019

pubmed: 28 6 2019

medline: 2 6 2020

entrez: 28 6 2019

Statut: ppublish

Résumé

Combining high-sensitivity cardiac Troponin T (hs-cTnT), NT-pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hs-CRP) may improve risk stratification of patients with pulmonary embolism (PE) beyond the PESI risk score. In the prospective multicentre SWITCO65+ study, we analysed 214 patients ≥ 65 years with a new submassive PE. Biomarkers and clinical information for the PESI risk score were ascertained within 1 day after diagnosis. Associations of hs-TnT, NT-proBNP, hs-CRP and the PESI risk score with the primary endpoint defined as 6-month mortality were assessed. The discriminative power of the PESI risk score and its combination with hs-cTnT, NT-proBNP and hs-CRP for 6-month mortality was compared using integrated discrimination improvement (IDI) index and net reclassification improvement (NRI). Compared with the lowest quartile, patients in the highest quartile had a higher risk of death during the first 6 months for hs-cTnT (adjusted HR 10.22; 95% CI 1.79-58.34; P = 0.009) and a trend for NT-proBNP (adjusted HR 4.3; 95% CI 0.9-20.41; P = 0.067) unlike hs-CRP (adjusted HR 1.97; 95% CI 0.48-8.05; P = 0.344). The PESI risk score (c-statistic 0.77 (95% CI 0.69-0.84) had the highest prognostic accuracy for 6-month mortality, outperforming hs-cTnT, NT-proBNP and hs-CRP (c-statistics of 0.72, 0.72, and 0.54), respectively. Combining all three biomarkers had no clinically relevant impact on risk stratification when added to the PESI risk score (IDI = 0.067; 95% CI 0.012-0.123; P = 0.018; NRI = 0.101 95% CI -0.099-0.302; P = 0.321). In elderly patients with PE, 6-month mortality can adequately be predicted by the PESI risk score alone.

Sections du résumé

BACKGROUND BACKGROUND

METHODS METHODS

In the prospective multicentre SWITCO65+ study, we analysed 214 patients ≥ 65 years with a new submassive PE. Biomarkers and clinical information for the PESI risk score were ascertained within 1 day after diagnosis. Associations of hs-TnT, NT-proBNP, hs-CRP and the PESI risk score with the primary endpoint defined as 6-month mortality were assessed. The discriminative power of the PESI risk score and its combination with hs-cTnT, NT-proBNP and hs-CRP for 6-month mortality was compared using integrated discrimination improvement (IDI) index and net reclassification improvement (NRI).

RESULTS RESULTS

Compared with the lowest quartile, patients in the highest quartile had a higher risk of death during the first 6 months for hs-cTnT (adjusted HR 10.22; 95% CI 1.79-58.34; P = 0.009) and a trend for NT-proBNP (adjusted HR 4.3; 95% CI 0.9-20.41; P = 0.067) unlike hs-CRP (adjusted HR 1.97; 95% CI 0.48-8.05; P = 0.344). The PESI risk score (c-statistic 0.77 (95% CI 0.69-0.84) had the highest prognostic accuracy for 6-month mortality, outperforming hs-cTnT, NT-proBNP and hs-CRP (c-statistics of 0.72, 0.72, and 0.54), respectively. Combining all three biomarkers had no clinically relevant impact on risk stratification when added to the PESI risk score (IDI = 0.067; 95% CI 0.012-0.123; P = 0.018; NRI = 0.101 95% CI -0.099-0.302; P = 0.321).

CONCLUSIONS CONCLUSIONS

In elderly patients with PE, 6-month mortality can adequately be predicted by the PESI risk score alone.

Identifiants

DOI: 10.1111/eci.13154 PMID: 31246275

pubmed: 31246275

doi: 10.1111/eci.13154

doi:

Substances chimiques

Peptide Fragments 0

TNNT2 protein, human 0

Troponin T 0

pro-brain natriuretic peptide (1-76) 0

Natriuretic Peptide, Brain 114471-18-0

C-Reactive Protein 9007-41-4

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

e13154

Subventions

Organisme : Swiss National Science Foundation

ID : 33CSCO-122659/139 470

Pays : Switzerland

Organisme : Swiss Heart Foundation

Informations de copyright

Références

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