What is the diagnostic or prognostic significance of measuring troponin and BNP levels in the setting of pulmonary embolism?

BNP

Reference
Cavallazzi R, et al.
Natriuretic peptides in acute pulmonary embolism: a systematic review. Intensive Care Med. 2008 Dec;34(12):2147-56.
Full-text

Objective
Evaluate the available evidence on (a) the accuracy of BNP for the diagnosis of right ventricular dysfunction and (b) value as a prognostic factor of all-cause in-hospital or short-term mortality in patients with PE

Particulars
16 studies were included in this review; 14 studies addressed BNP in the setting of PE. N of these studies ranged from 17 to 124.

Data
Fig. 3 in the article shows that for BNP cutoff level of 100 pg/ml, the pooled odds ratio for all-cause in-hospital mortality was 6.00

Troponin

Reference
Becattini C, et al. Prognostic value of troponins in acute pulmonary embolism: a meta-analysis. Circulation. 2007 Jul 24;116(4):427-33.
Full-text

Objective
To determine if elevated serum troponin levels identify patients with acute pulmonary embolism at high risk of short-term mortality or adverse outcome.

Particulars
20 studies (4 retrospective) were included in this review

Data
Results were consistent for troponin I or T and prospective or retrospective studies.
In patients with elevated troponin levels…

  • Odds Ratio (OR) for short-term mortality = 5.24 (95% CI, 3.28 to 8.38)
  • OR for death resulting from pulmonary embolism = 9.44 (95% CI, 4.14 to 21.49)
  • OR for adverse outcome events* = 7.03 (95% CI, 2.42 to 20.43)

*NOTE: Adverse outcome events were defined differently in the studies, but authors chose to pool data because all studies aimed to identify patients experiencing “in-hospital clinical deterioration.”

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About Amy

Clinical Informationist at EUH Branch Library
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