Assessment of sST2 Behaviors to Evaluate Severity/Clinical Impact of Acute Pulmonary Embolism

Abstract

Pulmonary embolism (PE) is a potentially life-threatening disorder. Beyond its usefulness in the prognostic stratification of heart failure, sST2 can represent a biomarker with high utility in several acute conditions. Our study was aimed to investigate whether sST2 can be used as a clinical marker of severity and prognostic outcome in acute PE. We enrolled 72 patients with documented PE and 38 healthy subjects; we measured the plasma concentrations of sST2 to evaluate the prognostic and severity performance of different levels of sST2 according to its association with the pulmonary embolism severity index (PESI) score and several parameters of respiratory function. PE patients had significantly higher levels of sST2 compared with healthy subjects (87.74 ± 17.1 vs. 17.1 ± 0.4 ng/mL, p < 0.001); we found higher PESI scores and serum lactate values in the group of patients with sST2 > 35 ng/mL compared with patients with sST2 < 35 ng/mL (138.7 ± 14.9 vs. 103.7 ± 15.1 and 2.43 ± 0.69 vs. 1.025 ± 0.05 mmol/L, respectively; p < 0.05). Patients with sST2 > 35 ng/mL showed higher radiological severity of PE compared with patients with sST2 < 35 ng/mL. Moreover, sST2 was the strongest parameter with a discriminative capacity for the development of acute respiratory failure and a PESI score >106 with respect to C reactive protein (CRP), creatinine, d-dimer, and serum lactate. We clearly demonstrated that sST2 significantly increased in PE and that its elevation was associated with disease severity. Therefore, sST2 may be used as a clinical marker in the evaluation of PE severity. However, further studies with larger patient populations are required to confirm these findings.

Pulmonary embolism post-Covid-19 infection: physiopathological mechanisms and vascular damage biomarkers

“…In this regard, in a recent study we have evaluated the behaviors of soluble ST2 (sST2), a cardiovascular injury-related biomarker currently recognized in the stratification of mortality in heart failure as well in acute infection diseases as Covid-19 pneumonia, in patients affected by acute PE. In this study, we have shown that sST2 levels are related to the extension of PE and its pathophysiological complications [ 15 ].…”

“…Recently, high interest was given also to the ST2 biomarker, as a possible laboratory parameter to assess the severity of the thromboembolic disease [ 15 ]. The soluble isoform sST2 is involved in the molecular signaling pathways related to the interleukin IL-33.…”

“…Initially studied to evaluate heart failure and atrial fibrillation prognosis in chronic conditions, recently it was considered also in acute conditions of heart failure and pulmonary embolism (PE), beyond for diagnostic purposes, also for prognostic role. Regarding pulmonary embolism, a recent study confirmed its potential usefulness in clinical practice to stratify the risk and to assess the disease severity [ 15 ].…”