Brief Report
Evaluation of B-type natriuretic peptide to predict complicated pulmonary embolism in patients aged 65 years and older: brief report

https://doi.org/10.1016/j.ajem.2006.02.007Get rights and content

Abstract

Purposes

We evaluated the use of plasma B-type natriuretic peptide (BNP) levels for risk stratification in elderly patients with acute pulmonary embolism (PE).

Basic Procedures

Bedside BNP assay was performed blindly at admission in consecutive patients older than 65 years with acute PE. A complicated PE was defined as any of the following: death, cardiopulmonary resuscitation, mechanical ventilation, use of vasopressors, thrombolysis, surgical embolectomy, or admission in intensive care unit.

Main Findings

Fifty-one patients (age, 79 ± 9 years) were included. Thirteen patients had adverse events: 11 were admitted in the intensive care unit and 3 died. The median BNP level (95% confidence interval [CI]) was higher in the group of patients with complicated PE, 274 pg/mL (95% CI, 142-581 pg/mL) vs 78 pg/mL (95% CI, 33-230 pg/mL) (P < .05), respectively. The receiver operating characteristic curve showed that BNP significantly predicted a complicated PE with an area under the receiver operating characteristic curve of 0.72 (95% CI, 0.58-0.83) (P < .05). The best threshold value was 200 pg/mL with a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 0.69 (0.43-0.87), 0.63 (0.47-0.77), 0.39 (0.22-0.59), 0.86 (0.69-0.94), and 0.65 (0.51-0.77), respectively.

Conclusion

Our study suggests that BNP is not a reliable marker of complicated PE in elderly patients.

Introduction

Accurate risk stratification is of paramount importance in selecting the optimal management strategy for patients with acute pulmonary embolism (PE) [1], [2], [3], [4]. Rapid, noninvasive, and accurate prognostic assessment with an inexpensive and widely available cardiac biomarker is an appealing approach. The cardiac myocytes can excrete several biomarkers when they are stretched or injured (eg, troponins I and T, B-type natriuretic peptide [BNP]). Although the release of troponins only occurs with degradation of the cardiac myocyte, the secretion of BNP is stimulated upon stretch of mainly the ventricular myocytes, especially in congestive heart failure [5], [6], [7]. Several studies have demonstrated that BNP or N-terminal pro-BNP (NT-pro-BNP) and troponins (T or I) are released during the early stage of massive PE-associated myocardial strain [8], [9], [10], [11], [12], [13], [14], [15], [16], but they evaluated the usefulness of BNP in risk stratification of PE only in middle-aged patients. However, higher natriuretic peptide levels have been observed in elderly patients [6], [7]. Therefore, we studied the use of plasma BNP levels for risk stratification in patients older than 65 years with acute PE.

Section snippets

Patients and methods

This prospective study took place in a medical ED of an urban teaching hospital with 1800 beds from September 2001 to April 2003. We obtained blood samples for BNP testing within the admission of consecutive patients older than 65 years with acute PE. The local ethics committee approved the study protocol (Comité Consultatif Pour les Personnes se prêtant à une Recherche Biomédicale), and waived informed consent was authorized because routine care of the patient was not modified.

The final

Results

From April 2001 to April 2003, we obtained blood samples for BNP testing within the admission in 51 consecutive patients older than 65 years with confirmed acute PE. The mean age was 79 ± 9 years (extremes, 65-100), 32 patients (63%) were older than 75 years, and there were 33 women and 18 men. The risk factors for venous thromboembolic diseases (VTEDs) were previous hospitalization less than 3 months in 19 (37%), personal history of VTED in 15 (29%), solid malignancy in 12 (24%), chronic

Discussion

To our knowledge, this is the first study that evaluated the usefulness of BNP in risk stratification of PE in patients older than 65 years. We confirmed that median BNP level was higher in the group of patients with right heart failure, and that median BNP level was higher in the group of complicated PE. However, we observed that BNP was not an accurate test to identify patients with a low risk of complicated PE in elderly patients (AUC of 0.72, with a sensitivity of 0.69 and a specificity of

Acknowledgments

This study was supported solely by departmental sources. The test and kits for BNP assay were provided free of charges by Biosite USA. The study sponsor has no involvement in the study design, in the collection and analysis of the data, and in the writing of the report. The manuscript was not submitted to Biosite. The authors thank the physicians and nursing staff working in the ED and all the physicians of the EPIDASA study group, Dr M-H Becquemin, Dr C Beigelman, Dr M Bennaceur, Dr S

References (17)

There are more references available in the full text version of this article.

Cited by (0)

View full text