title: The prognostic value of pro-B-Type natriuretic peptide in acute pulmonary embolism.
abstract: OBJECTIVE
  To assess the clinical performance of pro-B-type natriuretic peptide 1-108 (proBNP) for the prognosis of acute pulmonary embolism.
  
  
  METHODS
  This study was ancillary to a recently published multicentre study including 570 patients with acute pulmonary embolism. ProBNP values were analysed using a new sandwich immunoassay proBNP1-108, Bioplex2200 (Bio-Rade Laboratories). Data was compared with BNP and N-terminal (NT) proBNP values. Adverse outcomes at 30 days were defined as death, secondary cardiogenic shock, or recurrent venous thromboembolism.
  
  
  RESULTS
  ProBNP values were analysed in 549 patients, with 39 (7.1%) presenting adverse outcomes. All three natriuretic peptides were significantly elevated in these 39 patients compared with the group without adverse outcomes (BNP: p < 0.001; NT-proBNP: p < 0.001; proBNP: 0.044), with median proBNP values being 605 pg/ml (113-1437) and 109 pg/ml (30-444), respectively. Multivariate analyses revealed that proBNP significantly depended on patient age (p < 0.001) and renal failure (p=0.001), with proBNP values increasing with both factors. The areas under the receiver operating curve were 0.74 (95% CI 0.69-0.79) for BNP, 0.76 (95% CI 0.72-0.80) for NT-proBNP, and 0.70 (95% CI 0.65-0.75) for proBNP, meaning that the performance of proBNP was significantly lower than that of the two other peptides (p = 0.017).
  
  
  CONCLUSIONS
  ProBNP, BNP, and NT-proBNP values were significantly increased in patients with adverse outcomes after acute pulmonary embolism. However, the prognostic performance of proBNP for predicting adverse versus favourable outcomes was lower than that of the other natriuretic peptides, thus limiting the clinical relevance of proBNP as a prognostic marker in pulmonary embolism.
authors.affiliation: Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Acute Medicine Departement, Accidents and Emergency Unit, Brussel, Belgium. Franck.verschuren@uclouvain.be
authors.forename: Franck
authors.initials: F
authors.lastname: Verschuren
authors.forename: Mathieu
authors.initials: M
authors.lastname: Bonnet
authors.forename: Marie-Odile
authors.initials: MO
authors.lastname: Benoit
authors.forename: Damien
authors.initials: D
authors.lastname: Gruson
authors.forename: Francis
authors.initials: F
authors.lastname: Zech
authors.forename: Francis
authors.initials: F
authors.lastname: Couturaud
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meneveau
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Roy
authors.forename: Marc
authors.initials: M
authors.lastname: Righini
authors.forename: Guy
authors.initials: G
authors.lastname: Meyer
authors.forename: Olivier
authors.initials: O
authors.lastname: Sanchez
mesh_terms: D000208:Acute Disease; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis*; D012372:ROC Curve
chemical_list: D020097:Natriuretic Peptide, Brain