title: Importance of biomarkers in risk stratification of pulmonary thromboembolism patients.
abstract: BACKGROUND
  Patients with pulmonary thromboembolism (PTE) are classified into 3 groups according to the clinical risk factors associated with mortality. High-risk patients and some of the intermediate-risk patients should be treated immediately to decrease the high mortality risk. Although clinical risk level of PTE can be determined by using echocardiography to evaluate right ventricle overload and pulmonary artery pressure findings, it may not be available in all emergency settings.
  
  
  OBJECTIVE
  The purpose of the study was to define the laboratory biomarkers, which can be used in place of echocardiography for PTE risk stratification.
  
  
  METHODS
  Patients (n = 98) were divided into 3 groups as high-risk (n = 13), intermediate-risk (n = 50), and low-risk (n = 35) groups, according to clinical risk factors at the first referral to hospital. Hepatic, cardiac, and renal markers were evaluated and compared among 3 groups.
  
  
  RESULTS
  Among biomarkers examined, lactate dehydrogenase, urea, creatinine, uric acid, troponin I, N-terminal-pro-B-type natriuretic peptide, creatine kinase-MB, D-dimer, and erythrocyte sedimentation rate (ESR) levels were found different between groups. All of these biomarkers except for ESR had positive correlation, whereas ESR had negative correlation with the mortality risk. An analysis of covariance for the age difference among patient groups showed that all the biomarkers other than urea and D-dimer levels remained significantly different among risk groups.
  
  
  CONCLUSIONS
  At emergency conditions in which echocardiography assessment is not available, PTE patients who have increased levels of certain hepatic, cardiac, and renal biomarkers should cautiously be evaluated for having an increased risk for mortality. Increased levels of these biomarkers may guide the consideration for thrombolytic treatment.
authors.affiliation: From the *Department of Chest Diseases, Ankara Ataturk Training and Research Hospital; and †Department of Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey.
authors.forename: Elif
authors.initials: E
authors.lastname: Babaoglu
authors.forename: H Canan
authors.initials: HC
authors.lastname: Hasanoglu
authors.forename: Aysegul
authors.initials: A
authors.lastname: Senturk
authors.forename: Aysegul
authors.initials: A
authors.lastname: Karalezli
authors.forename: Hatice
authors.initials: H
authors.lastname: Kilic
authors.forename: Gokhan
authors.initials: G
authors.lastname: Aykun
authors.forename: Derya
authors.initials: D
authors.lastname: Oztuna
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011655:Pulmonary Embolism / Q000097:blood* / Q000175:diagnosis*; D018570:Risk Assessment; D014508:Urea / Q000097:blood
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D014508:Urea; D003404:Creatinine