A novel H-FABP assay and a fast prognostic score for risk assessment of normotensive pulmonary embolism.
We tested whether heart-type fatty acid binding protein (H-FABP) measured by a fully-automated immunoturbidimetric assay in comparison to ELISA provides additive prognostic value in patients with pulmonary embolism (PE), and validated a fast prognostic score in comparison to the ESC risk prediction model and the simplified Pulmonary Embolism Severity Index (sPESI). We prospectively examined 271 normotensive patients with PE; of those, 20 (7%) had an adverse 30-day outcome. H-FABP levels determined by immunoturbidimetry were higher (median, 5.2 [IQR; 2.7-9.8] ng/ml) than those by ELISA (2.9 [1.1-5.4] ng/ml), but Bland-Altman plot demonstrated a good agreement of both assays. The area under the curve for H-FABP was greater for immunoturbidimetry than for ELISA (0.82 [0.74-0.91] vs 0.78 [0.68-0.89]; P=0.039). H-FABP measured by immunoturbidimetry (but not by ELISA) provided additive prognostic information to other predictors of 30-day outcome (OR, 12.4 [95% CI, 1.6-97.6]; P=0.017). When H-FABP determined by immunoturbidimetry was integrated into a novel prognostic score (H-FABP, Syncope, and Tachycardia; FAST score), the score provided additive prognostic information by multivariable analysis (OR, 14.2 [3.9-51.4]; p<0.001; c-index, 0.86) which were superior to information obtained by the ESC model (c-index, 0.62; net reclassification improvement (NRI), 0.39 [0.21-0.56]; P<0.001) or the sPESI (c-index, 0.68; NRI, 0.24 [0.05-0.43]; P=0.012). In conclusion, determination of H-FABP by immunoturbidimetry provides prognostic information superior to that of ELISA and, if integrated in the FAST score, appears more suitable to identify patients with an adverse 30-day outcome compared to the ESC model and sPESI.
Claudia Dellas, Department of Cardiology and Pneumology, Heart Center, Georg August University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany, Tel.: +49 551 3912575, Fax: +49 551 3914142, E-mail: dellas@med.uni-goettingen.de.
Claudia
C
Dellas
Merle
M
Tschepe
Valerie
V
Seeber
Isabella
I
Zwiener
Katherina
K
Kuhnert
Katrin
K
Schäfer
Gerd
G
Hasenfuß
Stavros
S
Konstantinides
Mareike
M
Lankeit
D000368:Aged; D057205:Automation, Laboratory; D001794:Blood Pressure; D018450:Disease Progression; D004797:Enzyme-Linked Immunosorbent Assay; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D009391:Nephelometry and Turbidimetry / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D015203:Reproducibility of Results; D012131:Respiratory Insufficiency / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D012306:Risk; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis
C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins