title: Persistent NT-proBNP elevation in acute pulmonary embolism predicts early death.
abstract: OBJECTIVE
  Low levels of brain natriuretic peptides on admission identify low-risk patients with acute pulmonary embolism (APE) through their high NPV for mortality. However, increased natriuretic peptide values on admission are less helpful for identifying high-risk patients due to their low PPV. The aim of the study was to test whether the PPV for mortality can be improved by performing serial NT-proBNP measurements on admission, at 12 h, and at 24 h.
  
  
  RESULTS
  We prospectively included 113 consecutive patients with APE (mean age 63+/-18 years), of whom 10 had clinically massive APE. Thirty-day mortality was 15% (95% CI: 8%-22%). In survivors, median NT-proBNP levels decreased within 24 h from 1895 ng/L (range: 16-33,340) to 1007 ng/L (range: 9-33,243) (p<0.001). In non-survivors, median NT-proBNP levels at baseline (11,491 ng/L, range: 618-60,958) remained elevated at 24 h (8139 ng/L, range: 35-70,018; p=NS). The 30-day mortality rate in the group of 18 patients with NT-proBNP >7500 ng/L and less than 50% decrease of NT-proBNP within 24 h was 61% (95% CI: 39%-84%). PPV and NPV of NT-proBNP >7500 ng/L on admission and less than 50% decrease of NT-proBNP within 24 h were 61% and 94%, respectively.
  
  
  CONCLUSIONS
  Persistent elevation of plasma NT-proBNP levels within 24 h after APE diagnosis indicates ongoing right ventricular dysfunction with a poor prognosis. These critically ill patients may be candidates for rapid aggressive intervention, including thrombolysis, catheter thrombectomy, or surgical embolectomy.
authors.affiliation: Department of Internal Medicine and Cardiology, The Medical University of Warsaw, ul Lindleya 4, Warszawa, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Kostrubiec
authors.forename: Piotr
authors.initials: P
authors.lastname: Pruszczyk
authors.forename: Anna
authors.initials: A
authors.lastname: Kaczynska
authors.forename: Nils
authors.initials: N
authors.lastname: Kucher
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016017:Odds Ratio; D010446:Peptide Fragments / Q000097:blood*; D011044:Poland / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000097:blood* / Q000401:mortality*; D012372:ROC Curve; D018497:Ventricular Dysfunction, Right / Q000097:blood
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain