Elevated Pro-BNP/BNP Predicts 90-Day Outcomes in Patients With Pulmonary Embolism

Abstract

The role of cardiac biomarkers (Pro-BNP/BNP and Troponin I) as a prognostic tool in pulmonary embolism (PE) has been previously described. It was shown to predict in-hospital and short term mortality in PE patients. In this study, we address the role of cardiac biomarkers as a predictor of readmission rate.METHODS: A retrospective study was conducted in 176 patients with a primary diagnosis of PE between May 2017 to December 2018. Among these, pro-BNP/BNP or Troponins at the time of admission was not available in 75 patients and they were excluded. Troponins or pro-BNP/BNP above the reference range in our laboratory were considered as high. Vitals obtained at admission and echocardiographic evidence of right ventricular hypokinesia was also noted. Readmissions due to cardio-pulmonary complications or complications associated with PE within 90 days or death were considered as primary outcome. Logistic regression analysis was used to examine the association between baseline characteristics, vitals, imaging and cardiac biomarkers with primary outcomes. RESULTS:Of the 101 patients, 17% (n¼17) had readmissions due to cardiopulmonary causes or complications from PE including deaths. The incidence of primary outcomes was 27.9% (12/43) in patients with high pro-BNP/BNP vs 8.6% (5/58) in the normal pro-BNP/BNP (p¼0.01). Readmission rate was higher in females 23.2% (13/56) vs 8.9% (4/45) in males, though it was not statistically significant (p¼0.065). Patients' age, baseline clinical parameters, RV hypokinesis on echocardiogram and troponins were similar in both groups. A multivariate logistic regression model using all the above parameters showed that only elevated Pro-BNP/BNP is predictive of the primary outcome (adjusted OR ¼ 4.03, 95% CI ¼ 1.10, 14.70; p¼0.035).CONCLUSIONS: Pro-BNP/BNP is an important prognostic marker in PE patients. Along with risk stratifying patients during admission, it can be used as a predictor of readmissions, short term cardiovascular complications and death.CLINICAL IMPLICATIONS: ProBNP/BNP should be obtained in every PE patient during the time of admission. Elevated Pro-BNP/BNP values in PE can identify high risk patients who may need aggressive follow up.

Charlson and Elixhauser Comorbidity Indices for Prediction of Mortality and Hospital Readmission in Patients With Acute Pulmonary Embolism

“…To our knowledge, none have applied the ECI to this outcome. 11 , 27 - 29 In our study only the CCI was associated with readmission in the univariate analysis with poor discriminatory power. The ECI was not associated with readmission.…”

“… 10 It has since been assessed for 90-day mortality, 6-month mortality, 1-year mortality, and hospital readmission. 11 , 12 This index has been used to guide clinical decision-making regarding patients who may be suitable for early discharge and/or ambulatory treatment. 13 , 14 The sPESI score, tailored to 6 variables, was introduced to provide clinicians with a more streamlined and efficient method of predicting short-term mortality risk in acute PE.…”

Surgical Prevention of Thromboembolic Complications in Transfascial Thrombosis

“…Водночас закордонні автори у своїх прогностичних шкалах ризику венозних тромбоемболічних ускладнень, зокрема PESI (Pulmonary Embolism Severity Index) [9], Vienna Prediction Model [8], Wells [18], Padua Prediction Score [1], Caprini [2], Geneva Score [10], жодним чином не згадують про тромбофлебіт поверхневих вен, хоча частота тромбозу глибоких вен, спровокованого гострим варикотромбофлебітом, сягає 2,5-44 % [5,13,19]. Цьому передусім сприяють неспроможність венозного клапанного апарату та швидке наростання тромботичного процесу -до 30-35 см протягом доби [13].…”