The significance of determining humoral biomarkers in venous blood in predicting outcomes in different subgroups of patients with pulmonary thromboembolism

[Lj. Z. Jovanović]

89 listova

Uvod. Plućna tromboembolija (PTE) je globalni zdravstveni problem povezan sa značajnim morbiditetom i mortalitetom. Cilj ove studije je procena prognostičkih mogućnosti BNP-a, CRP-a, cTNI, ukupnog holesterola i D-Dimera u predviđanju 30-to dnevne smrtnosti kod pacijenata sa PTE izazvane spontanim ili provocirajućim (prolaznim ili dugotrajnim) faktorima. Pacijenti i metode istraživanja. Retrospektivna studija uključila je 1070 pacijenata sa dijagnozom PTE potvrđenom multi-detektorskom kompjuterizovanom tomografijom sa pulmoangiografijom. Koncetracije biomarkera u krvi merene su tokom prvih 24 sata od hospitalizacije. Kao krajnji ishod studije definisana je rana 30-to dnevna smrtnost. Rezultati su izraženi kao medijana (25-ti - 75-ti percentil) obzirom da istraživani parametri nisu imali normalnu distribuciju. Poređenje grupa izvršeno je pomoću Pearson-ovog Hi-kvadrat testa, Fisher-ovog egzaktnog testa i Mann-Whitney U testa. Sprovedena je ROC analiza (površina ispod krive računata sa 95% intervalom pouzdanosti) koja ukazuje na prognostičku vrednost biomarkera i njihove optimalne cutoff vrednosti. Rezultati. Od ukupnog broja pacijenata, 125 (11.7%) umrlo je u okviru od 30-dana od prijema (8.2%, 11.6%, 20.4%, u spontanoj, kratkotrajno i dugotrajno provociranoj PTE, redom). BNP je pokazao najsnažniju prediktivnu vrednost u predviđanju smrtnog ishoda kod pacijenata sa PTE provociranom prolaznim faktorima (AUC=0.762, CI 0.658-0.866, p=0.002) i nešto nižu u spontano izazvanoj PTE (AUC=0.685, CI 0.490-0.881, p=0.031). CRP i cTnI su imali najbolje prognostičke mogućnosti kod spontane PTE. Ukupni holesterol je prikazao skromnu prediktivnu moć kod dugotrajno provocirane PTE. D-Dimer nije značajnije učestvovao u prognozi smrtnosti ni u jednoj grupi pacijenata. Zaključak. U odnosu na spontane, prolazne ili dugotrajne uzroke nastanka PTE, biohemijski profil ovih grupa pacijenata je značajno različit, kao i prognostička moć biomarkera kod procene 30-to dnevne smrtnosti.

Introduction: Pulmonary thromboembolism (PTE) is global health problem associated with significant morbidity and mortality. The aim of this study was to evaluate the prognostic ability of BNP, CRP, cTnI, total cholesterol and D-Dimer for the prediction of all-cause 30-day mortality in PTE patients regarding whether they classified as spontaneous, transiently provoked and permanently provoked PTE. Patients and methods. А retrospective study included 1070 patients with diagnosis of PTE confirmed by multidetector computed tomography pulmonary angiography. Blood concentrations of biomarkers were measured during the first 24 h of hospitalization. The endpoint of study was short-term (30-days) all-cause mortality. The results were expressed as median with 25th-75th percentile range since the examined variables did not have normal distributions. Comparison of the groups was done by the Pearson Hi-square test, the Fisher Exact Test and the Mann-Whitney U test. Area under the receiver-operating characteristics (ROC) curve was used to determine the prognostic value of biomarkers and to select optimal cutoffs. Results. Among all patients, 125 (11.7%) died within 30 days (8.2%, 11.6%, 20.4%, in spontaneous, transient and persistent provoked PTE, respectively). BNP blood level had the strongest predictive value for the primary outcome in transient provoked PTE (AUC=0.762, CI 0.658-0.866, p=0.002) and a slightly lower in spontaneous PTE (AUC=0.685, CI 0.490-0.881, p=0.031). CRP and cTnI showed their best prognostic performance in spontaneous PTE. Total cholesterol demonstrated modest predictive power for the short-term mortality in the group with permanently provoked PTE. D-Dimer did not contribute significantly to the prediction of primary outcome in either group. Conclusion. Patients with spontaneous, transient and persistent provoked PTE showed significantly different profile of biomarkers level and various predictive power for early 30-days allcause mortality.

biomarkeri, smrtnost, plućna tromboembolija

biomarkers, mortality, pulmonary thromboembolism

616.24-005.7(043.3)

Tekst