Validation of N-terminal pro-brain natriuretic peptide cut-off values for risk stratification of pulmonary embolism
2014 | journal article; research paper. A publication with affiliation to the University of Göttingen.
Jump to: Cite & Linked | Documents & Media | Details | Version history
Cite this publication
Validation of N-terminal pro-brain natriuretic peptide cut-off values for risk stratification of pulmonary embolism
Lankeit, M. ; Jimenez, D.; Kostrubiec, M.; Dellas, C. ; Kuhnert, K.; Hasenfuß, G. & Pruszczyk, P. et al. (2014)
European Respiratory Journal, 43(6) pp. 1669-1677. DOI: https://doi.org/10.1183/09031936.00211613
Documents & Media
Details
- Authors
- Lankeit, Mareike ; Jimenez, David; Kostrubiec, Maciej; Dellas, Claudia ; Kuhnert, Katherina; Hasenfuß, Gerd ; Pruszczyk, Piotr; Konstantinides, Stavros
- Abstract
- The optimal N-terminal pro-brain natriuretic peptide (NT-proBNP) cut-off value for risk stratification of pulmonary embolism remains controversial. In this study we validated and compared different proposed NT-proBNP cut-off values in 688 normotensive patients with pulmonary embolism. During the first 30 days, 28 (4.1%) patients reached the primary outcome (pulmonary embolism-related death or complications) and 29 (4.2%) patients died. Receiver operating characteristic analysis yielded an area under the curve of 0.70 (0.60-0.80) for NT-proBNP. A cut-off value of 600 pg.mL(-1) was associated with the best prognostic performance (sensitivity 86% and specificity 50%) and the highest odds ratio (6.04 (95% CI 2.07-17.59), p=0.001) compared to the cut-off values of 1000, 500 or 300 pg.mL(-1). Using multivariable logistic regression analysis, NT-proBNP >= 600 pg.mL(-1) had a prognostic impact on top of that of the simplified Pulmonary Embolism Severity Index and right ventricular dysfunction on echocardiography (OR 4.27 (95% CI 1.22-15.01); p=0.024, c-index 0.741). The use of a stepwise approach based on the simplified Pulmonary Embolism Severity Index, NT-proBNP >= 600 pg.mL(-1) and echocardiography helped optimise risk assessment. Our findings confirm the prognostic value of NT-proBNP and suggest that a cut-off value of 600 pg.mL-1 is most appropriate for risk stratification of normotensive patients with pulmonary embolism. NT-proBNP should be used in combination with a clinical score and an imaging procedure for detecting right ventricular dysfunction.
- Issue Date
- 2014
- Publisher
- European Respiratory Soc Journals Ltd
- Journal
- European Respiratory Journal
- ISSN
- 0903-1936
- eISSN
- 1399-3003