title: Evaluation of B-type natriuretic peptide to predict complicated pulmonary embolism in patients aged 65 years and older: brief report.
abstract: OBJECTIVE
  We evaluated the use of plasma B-type natriuretic peptide (BNP) levels for risk stratification in elderly patients with acute pulmonary embolism (PE).
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Our study suggests that BNP is not a reliable marker of complicated PE in elderly patients.
authors.affiliation: Department of Emergency Medicine and Surgery, Centre Hospitalo-Universitaire (CHU) Pitié-Salpêtrière, Assistance-Publique Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie (Paris 6), 75013 Paris, France. patrick.ray@psl.ap-hop-paris.fr
authors.forename: Patrick
authors.initials: P
authors.lastname: Ray
authors.forename: Franck
authors.initials: F
authors.lastname: Maziere
authors.forename: Sassi
authors.initials: S
authors.lastname: Medimagh
authors.forename: Yannick
authors.initials: Y
authors.lastname: Lefort
authors.forename: Martine
authors.initials: M
authors.lastname: Arthaud
authors.forename: Alexandre
authors.initials: A
authors.lastname: Duguet
authors.forename: Antonio
authors.initials: A
authors.lastname: Teixeira
authors.forename: Bruno
authors.initials: B
authors.lastname: Riou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005853:Geriatrics / Q000379:methods; D006801:Humans; D007902:Length of Stay; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D020097:Natriuretic Peptide, Brain