Full Text
Introduction
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Prospective studies have demonstrated that clinical factors, echocardiographic right ventricular dysfunction and cardiac biomarkers are independent predictors of short-term mortality in patients with PE. However, longer-term predicting factors are not well known.
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Materials & Methods
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We evaluated the long-term meaning of Pro-BNP measured early during the admission because of acute pulmonary embolism in successive patients, and its influence in long-term survival.
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Plasma Pro-BNP was measured (Elecsys Roche Diagnostics, Mannheim, Germany) in the first 48 hours after the diagnosis of pulmonary embolism was obtained.
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Follow up of patients was carried out through the computerized medical records of Health Service of Navarra and by means of telephone calls.
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Results
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One hundred and ninety-three patients were evaluated, median age 76 years (I
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QR
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16), female 52%
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PE was diagnosed by
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CT
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angiography in 188 (97%) patients and by means of pulmonary scintigraphy in 5 (3%) patients.
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During a mean time of follow up of 28 months, 45 (23%) patients died, 14 (7%) of them during the admission index.
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Causes of delayed death were: Pulmonary embolism 21, hemorrhage 4, cancer 3, death by other cardiovascular causes 7, infections 6, other causes 2, unknown 1 patient.
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Median Pro-BNP in dead patients was 3,070 (IQR 7243) ng/L, while in survivors was 701 (IQR 2488) ng/L (p<.001).
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In multiple logistic regression, age, pro-BNP and systolic blood pressure, were independent variables associated with death.
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At 10 months of follow up, log rank analysis showed different probability of survival (p=.012) with a difference in mortality rate of 22% in patients with pro-BNP higher than 500 ng/L in index episode.
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Conclusions
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In the setting of acute pulmonary embolism, among other factors, pro-BNP measured at index admission could represent a medium-term prognostic factor, signalling probability of overall death. However, beyond 10 months pro-BNP failed as prognostic factor.
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