Natriuretic peptides in acute pulmonary embolism: a systematic review.
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.


OBJECTIVE
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.


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


METHODS
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.


CONCLUSIONS
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.
Cavallazzi
Rodrigo
R
Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, 834 Walnut Street, Suite 650, Philadelphia, PA 19107, USA.
Nair
Abhilash
A
Vasu
Tajender
T
Marik
Paul E
PE
D015415:Biomarkers / Q000097:blood; D006801:Humans; D016013:Likelihood Functions; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016017:Odds Ratio; D010446:Peptide Fragments / Q000097:blood*; D011655:Pulmonary Embolism / Q000097:blood* / Q000150:complications; D012372:ROC Curve; D018497:Ventricular Dysfunction, Right / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain