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Natriuretic peptides in acute pulmonary embolism: a systematic review

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Abstract

Background

Patients with pulmonary embolism (PE) have a high risk of death, and it is important to recognize factors associated with higher mortality. Recently, several biomarkers have been studied for risk stratification in patients with PE.

Objectives

Evaluate the available evidence on (a) the accuracy of brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) for the diagnosis of right ventricular dysfunction and (b) their value as a prognostic factor of all-cause in-hospital or short-term mortality in patients with PE.

Data sources

MEDLINE, Embase, and citation review of relevant primary and review articles.

Selection criteria

We selected studies evaluating the accuracy of BNP or NT-proBNP for the diagnosis of right ventricular dysfunction. We also selected studies that reported data on BNP or NT-proBNP as a predictor of short-term mortality in patients with PE.

Results

Sixteen studies met our inclusion criteria. The pooled diagnostic odds ratio for the diagnosis of right ventricular dysfunction in pulmonary embolism was 39.45 (95% CI; 15.54–100.12) and 24.73 (95% CI 2.02–302.37) for BNP and NT-proBNP, respectively. The pooled odds ratio for all-cause in-hospital or short-term mortality was 6 (95% CI 1.31–27.43; p: 0.021) and 16.12 (95% CI 3.1–83.68; p: 0.001) for BNP (cutoff: 100 pg/ml) and NT-proBNP (cutoff: 600 ng/L), respectively.

Conclusion

The results of this meta-analysis indicate that BNP and NT-proBNP are associated with the diagnosis of right ventricular dysfunction (RVD) in patients with an acute PE and are significant predictors of all-cause in-hospital or short-term mortality in these patients.

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Acknowledgments

We thank Drs. David G. Kiely and Filippo Pieralli for providing additional information on their respective studies.

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Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, 834 Walnut Street, Suite 650, Philadelphia, PA, 19107, USA

    Rodrigo Cavallazzi, Abhilash Nair, Tajender Vasu & Paul E. Marik

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  1. Rodrigo Cavallazzi
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  2. Abhilash Nair
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  3. Tajender Vasu
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Correspondence to Paul E. Marik.

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Cavallazzi, R., Nair, A., Vasu, T. et al. Natriuretic peptides in acute pulmonary embolism: a systematic review. Intensive Care Med 34, 2147–2156 (2008). https://doi.org/10.1007/s00134-008-1214-5

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