Risk stratification of elderly patients with acute pulmonary embolism.

Klingenberg, Roland; Schlager, Oliver; Limacher, Andreas; Méan, Marie; Vuilleumier, Nicolas; Beer, Juerg H; Staub, Daniel; Frauchiger, Beat; Aschwanden, Markus; Lämmle, Bernhard; Righini, Marc; Egloff, Michael; Osterwalder, Joseph; Angelillo, Anne; Kucher, Nils; Banyai, Martin; Rodondi, Nicolas; von Eckardstein, Arnold; Aujesky, Drahomir; Husmann, Marc; ... (2019). Risk stratification of elderly patients with acute pulmonary embolism. European journal of clinical investigation EJCI, 49(9), e13154. Wiley-Blackwell 10.1111/eci.13154

	Text Klingenberg EurJClinInvest 2019_epub.pdf - Published Version Restricted to registered users only Available under License Publisher holds Copyright. Download (157kB)
Preview	Text Klingenberg EurJClinInvest 2019.pdf - Accepted Version Available under License Publisher holds Copyright. Download (346kB) | Preview

BACKGROUND

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.

METHODS

In the prospective multicenter SWITCO65+ study, we analyzed 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

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

In elderly patients with PE, 6-month mortality can adequately be predicted by the PESI risk score alone. This article is protected by copyright. All rights reserved.

Interest & Impact

Downloads

169 since deposited on 18 Jul 2019
8 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item