The N-terminal pro-brain-type natriuretic peptide based short-term prognosis in patients with acute pulmonary embolism according to renal function

Abstract

N-terminal pro-brain-type natriuretic peptide (NT-proBNP) is currently used for risk stratification in acute pulmonary embolism (PE). We aimed to clarify the impact of renal function on the validity of the NT-proBNP based prognosis, assuming that the biomarker is accumulated in renal insufficiency. The NT-proBNP based prediction of PE related in-hospital death was investigated according to renal function in 329 patients with acute PE. The normalized NT-proBNP ratios (NT-proBNP level divided by the age-adjusted normal upper range) were inversely correlated (r = -0.414, P < 0.001) to the estimated glomerular filtration rates (eGFR). A cut-off point of ≥ 2.5 for the normalized NT-proBNP ratio was found to be best for the prediction of mortality (AUC 0.716, 95% CI 0.626-0.805, P < 0.001) and was a significant predictor for death in univariate and multivariate analysis. A normalized NT-proBNP ratio ≥ 2.5 was a significant predictor for PE-mortality only in patients with an eGFR ≥ 60 ml/min/1.73 m². Renal insufficiency significantly predicted mortality in univariate but not in multivariate analysis. High-risk PE and cerebrovascular diseases were significantly more frequent in renal dysfunction and significantly predicted death in univariate and multivariate analysis. The validity of the NT-proBNP based short-term prognosis might be limited in renal dysfunction not only by accumulation, but also because renal insufficiency itself and concurrent conditions are contributing to PE related mortality.

Glomerular Filtration Rate as a Prognostic Factor for Long-Term Mortality after Acute Pulmonary Embolism

“…Monreal et al [11] show that the ORs for fatal PE in patients with CrCl between 30 and 60 mL/min and in those with CrCl < 30 mL/min are 2.7 and 7.2, respectively, compared to subjects in whom CrCl was > 60 mL/min. Kidney dysfunction has been previously observed in patients with acute PE and was found to be associated with worse short-term outcomes [12-14]. GFR was lower in nonsurvivors than in survivors (35 vs. 63 mL/min, p < 0.0001) in a prospective cohort study performed in Poland with AUC values similar to our study [13].…”

“…Although various studies show the impact of renal dysfunction on the short-term prognosis in these patients [10-15], few studies have assessed its effect on long-term mortality [15], hence, the importance of decreased renal function as a prognostic marker is yet to be fully determined. Acute PE itself can contribute to acute kidney injury, which predicts higher all-cause mortality in 30 days [16] in addition to previously observed kidney dysfunction and worse short-term outcomes in case of a PE event [13, 14]. …”

Renal biomarkers and prognosis in acute pulmonary embolism

“…In contrast to previous studies4 5 the authors were able to demonstrate that haemodynamic compromise during APE might have contributed to renal dysfunction, as markers of acute kidney injury were associated with signs of acute right ventricular dysfunction or increased central venous pressure. Sudden pressure overload in the pulmonary circulation due to APE may lead to acute right ventricular dysfunction along with tricuspid regurgitation.…”

“…Impaired kidney function may not only reflect chronic renal disease but also deterioration secondary to haemodynamic disturbances, as decreased cardiac output and elevated central venous pressure may contribute to renal insufficiency 3. Kidney dysfunction has previously been observed in patients with acute pulmonary embolism (APE) and was found to be associated with worse short-term outcomes 4 5. However, those studies were not able to distinguish between acute kidney injury due to haemodynamic compromise cause by APE or chronic pre-existing renal insufficiency.…”

Καρδιαγγειακές Επιπλοκές Σε Ορθοπαιδικό Χειρουργείο

“…Overall 242 patients (age 80(74)(75)(76)(77)(78)(79)(80)(81)(82)(83)(84)(85)) undergoing major orthopedic surgery were inrolled in this prospective study. The endpoint was in hospital cardiac events and mortality at 1-year follow up.…”