Risk stratification of pulmonary embolism: clinical evaluation, biomarkers or both?

Meyer, Guy; Planquette, Benjamin; Sanchez, Olivier

doi:10.1183/13993003.01562-2015

Cited by 6 publications

(3 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In comparison, recent derivation cohort studies developing combination models for the identification of intermediate-high-risk PE patients reported complication rates of >20% in the high-risk groups (PREP score, 22.2% [24]; FAST score, 20.5% [25]; Bova score, 29.2% [3]). If we assume the same relative risk reduction in these "truly" intermediate-high-risk patients, the risk-to-benefit ratio could be tipped in favour of thrombolytic therapy [26]. Thus, in the present study, we used copeptin ⩾24 pmol·L −1 to further identify patients at intermediate-high risk classified by the 2014 ESC algorithm at highest risk (figure 2c).…”

Section: Improving Risk Stratification Based On the 2014 Esc Algorithmentioning

confidence: 99%

Prognostic impact of copeptin in pulmonary embolism: a multicentre validation study

Hellenkamp¹,

Pruszczyk

Jiménez

et al. 2018

Eur Respir J

View full text Add to dashboard Cite

To externally validate the prognostic impact of copeptin, either alone or integrated in risk stratification models, in pulmonary embolism (PE), we performed a analysis of 843 normotensive PE patients prospectively included in three European cohorts.Within the first 30 days, 21 patients (2.5%, 95% CI 1.5-3.8) had an adverse outcome and 12 (1.4%, 95% CI 0.7-2.5) died due to PE. Patients with copeptin ≥24 pmol·L had a 6.3-fold increased risk for an adverse outcome (95% CI 2.6-15.5, p<0.001) and a 7.6-fold increased risk for PE-related death (95% CI 2.3-25.6, p=0.001). Risk classification according to the 2014 European Society of Cardiology (ESC) guideline algorithm identified 248 intermediate-high-risk patients (29.4%) with 5.6% (95% CI 3.1-9.3) at risk of adverse outcomes. A stepwise biomarker-based risk assessment strategy (based on high-sensitivity troponin T, N-terminal pro-brain natriuretic peptide and copeptin) identified 123 intermediate-high-risk patients (14.6%) with 8.9% (95% CI 4.5-15.4) at risk of adverse outcomes. The identification of patients at higher risk was even better when copeptin was measured on top of the 2014 ESC algorithm in intermediate-high-risk patients (adverse outcome OR 11.1, 95% CI 4.6-27.1, p<0.001; and PE-related death OR 13.5, 95% CI 4.2-43.6, p<0.001; highest risk group all other risk groups). This identified 85 patients (10.1%) with 12.9% (95% CI 6.6-22.0) at risk of adverse outcomes and 8.2% (95% CI 3.4-16.2) at risk of PE-related deaths.Copeptin improves risk stratification of normotensive PE patients, especially when identifying patients with an increased risk of an adverse outcome.

show abstract

Section: Improving Risk Stratification Based On the 2014 Esc Algorithmentioning

confidence: 99%

Prognostic impact of copeptin in pulmonary embolism: a multicentre validation study

Hellenkamp¹,

Pruszczyk

Jiménez

et al. 2018

Eur Respir J

View full text Add to dashboard Cite

show abstract

“…Different states and diseases, sometimes very clearly and sometimes completely hidden, very often underlie PE and their presence is often crucial for the management and prognosis of patients with PE. The determination of some blood biomarkers at admission and during the treatment of PE is the part of routine diagnostic process and estimation of mortality risk [8][9][10]. The blood levels of different biomarkers used in PE patients for different purposes such as brain natriuretic peptides (BNP), cardiac troponins (cTnI), D-dimer and C reactive protein (CRP) depend on different but somehow connected pathophysiology mechanisms and it is clear that many of the underlying PE diseases and states can have strong influence of that levels.…”

Section: Introductionmentioning

confidence: 99%

Different predictive value for short-term all-cause mortality with commonly used biomarkers regarding the cause of pulmonary embolism

et al. 2021

View full text Add to dashboard Cite

Background/Aim. The evaluation of blood levels of cardiac troponin-I (cTnI), D-dimer, B-type natriuretic peptide (BNP) and C-reactive protein (CRP) at admission and during the treatment of pulmonary embolism (PE) are the part of routine diagnostic process and estimation of mortality risk. The aim of this study was to evaluate the predictive value of these biomarkers at admission for all-cause 30-day mortality in consecutive PE patients regarding whether they classified as spontaneous, transiently provoked and permanently provoked PE. Methods. This retrospective analysis is gained from the data of 590 PE patients from the Serbian University Multicenter Pulmonary Embolism Registry (SUPER). Patients had at least one of these biomarkers (BNP, CRP, cTnI and D-dimer) measurements during the first 24 hours from the admission. Results. ROC curve analyses demonstrated that BNP had the highest prognostic accuracy for 30-day mortality in patients (N=219) who had data for all examined biomarkers. BNP provided an AUC of 0.785 (p<0.001). Separately BNP had the highest c-statistic for all three groups of patients. CRP had modest predictive value for the 30-day all-cause mortality in the group with transient provoked PE. Troponin I had very modest predictive value for the 30-day all-cause mortality only in patients with spontaneous PE and D-dimer was very weak predictor of this end-point only in patients with persistent provoked PE. Conclusion. Patients with spontaneous, transient provoked and persistent provoked PE have significantly different profile of blood biomarkers level with different prognostic significance for early all-cause mortality.

show abstract

“…It should be noted that the PESI has a high negative predictive value but a low positive predictive value. 10 This means that the PESI does not adequately identify high-risk patients among normotensive patients requiring intensive monitoring and, in some cases, treatments that are more aggressive. Other scores are more appropriate for this purpose, including the Bova score (a systemic blood pressure of 90-100 mmHg, elevated troponin levels, right ventricular dysfunction as assessed by echocardiography or CT, and a heart rate ≥ 110 bpm); Prognostic Factors for Pulmonary Embolism, including altered mental status, cardiogenic shock on admission, cancer, serum brain natriuretic peptide (BNP) levels, and right ventricular/left ventricular ratio as assessed by echocardiography; and the Heart-type Fatty Acid-Binding Protein, Syncope, and Tachycardia score.…”

mentioning

confidence: 99%

Should we use prognostic scores for acute pulmonary thromboembolism in clinical practice?

Gazzana

Benedetto

2019

J. bras. pneumol.

View full text Add to dashboard Cite

Risk stratification of pulmonary embolism: clinical evaluation, biomarkers or both?

Cited by 6 publications

References 15 publications

Prognostic impact of copeptin in pulmonary embolism: a multicentre validation study

Prognostic impact of copeptin in pulmonary embolism: a multicentre validation study

Different predictive value for short-term all-cause mortality with commonly used biomarkers regarding the cause of pulmonary embolism

Should we use prognostic scores for acute pulmonary thromboembolism in clinical practice?

Contact Info

Product

Resources

About