Plasma N-terminal pro-brain natriuretic peptide concentrations may help to identify patients with very low-risk acute pulmonary embolism: A preliminary study

• Published in: Advances in clinical and experimental medicine : official organ Wroclaw Medical University Vol. 34; no. 4; pp. 605 - 611
• Main Authors: Karolak, Bartosz, Skowrońska, Marta, Machowski, Michał, Dzikowska-Diduch, Olga, Bienias, Piotr, Kuryła, Martyna, Wiśniewska, Małgorzata, Gołębiowski, Marek, Pruszczyk, Piotr, Ciurzyński, Michał
• Format: Journal Article
• Language: English
• Published: Poland 01.04.2025
• Subjects: Acute Disease; Adult; Aged; Biomarkers - blood; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain - blood; Peptide Fragments - blood; Prospective Studies; Pulmonary Embolism - blood; Pulmonary Embolism - diagnosis; Pulmonary Embolism - mortality; ROC Curve; Severity of Illness Index; outcome prediction; pulmonary embolism; N-terminal pro-brain natriuretic peptide
• ISSN: 1899-5276
• DOI: 10.17219/acem/187187

Patients with an acute pulmonary embolism (APE) are a heterogeneous group, and some of them may benefit from early discharge and an ambulatory care referral. We aimed to evaluate the use of N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma level assessment in patients with low-risk APE based on clinical findings (0 points on the simplified Pulmonary Embolism Severity Index (sPESI)). Preliminary analysis of an ongoing prospective study including 1,151 normotensive patients with at least a segmental APE. In the final analysis, 348 patients with a 0-point sPESI were included. Blood samples were collected within the first 24 h of admission. The clinical endpoint (CE) included APE-related mortality and/or rescue thrombolysis in patients with clinical deterioration. Clinical endpoints occurred in 3 patients who had higher plasma NT-proBNP levels than study participants with a favorable clinical course (164 [64-650] pg/mL compared to 2,930 [2,285.5-13,965] pg/mL; p = 0.01). Receiver operating characteristic (ROC) analysis showed that the area under the curve (AUC) for NT-proBNP for the prediction of the CEs was 0.918 (95% confidence interval [95% CI]: 0.831-1.00; p = 0.013). We defined the cutoff value of NT-proBNP at ≥1,641 pg/mL. Among subjects with 0 points on the sPESI, those with concentrations of NT-proBNP exceeding 1,641 pg/mL might require closer attention; remaining patients could be considered candidates for outpatient treatment. However, these findings warrant further investigation in a large, prospective group of patients.