title: N-terminal Pro-B type natriuretic peptide as long-term predictor of death after an acute pulmonary embolism.
abstract: OBJECTIVE
  After an acute pulmonary embolism few long-term prognostic factors have shown to be of practical use. We hypothesized that, as in heart failure, natriuretic peptides could serve as biomarkers of a late deleterious prognosis.
  
  
  METHODS
  Consecutive patients admitted to an Internal Medicine ward diagnosed with acute pulmonary embolism were traced through the computerized system of clinical episodes of Navarra Health System and by telephone calls. On hospitalization, standard evaluation was made, previous history of cancer and cardiac disease was recorded, and N-terminal ProB-type natriuretic peptide (NT-ProBNP), D-dimer and Troponin I were measured. In the analysis all-causes death was considered.
  
  
  RESULTS
  Two hundred and thirty-four patients were traced, median age 75 [interquartile range (IQR) 16] years old, women 51%. At a median time of 9.5 (IQR 29) months 52 (22%) patients had died, 38 (73%) dead patients had NT-ProBNP higher than 850 ng/L. NT-ProBNP in dead patients was 2.741 (IQR 7.420)ng/L and 662 (IQR 2.517)ng/L in survivors (p<0.001). Age (OR 4.37 CI 95% 1.04-1.16) and NT-ProBNP (OR 1.49 CI 95% 1-1.002) showed to be independent factors of mortality. Between the 3rd and 20th month after the diagnosis, a level of NT-ProBNP higher than 850 ng/L (sensitivity 0.86, specificity 0.45 and negative predictive value 0.92) was associated with a lower survival (p=0.019), hazard ratio 1.89, OR 7.67 (CI 95% 1.52-39.44) for this period.
  
  
  CONCLUSIONS
  Besides the unchangeable age, plasma level of NT-ProBNP measured on acute pulmonary embolism could predict longer-term all-cause death.
authors.affiliation: Department A of Internal Medicine, Hospital Complex of Navarra, Irunlarrea 6, 31008 Pamplona, Spain. Electronic address: jalonsom@cfnavarra.es.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Alonso-Martínez
authors.affiliation: Department A of Internal Medicine, Hospital Complex of Navarra, Irunlarrea 6, 31008 Pamplona, Spain.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Annicchérico-Sánchez
authors.affiliation: Department A of Internal Medicine, Hospital Complex of Navarra, Irunlarrea 6, 31008 Pamplona, Spain.
authors.forename: Miren Aránzazu
authors.initials: MA
authors.lastname: Urbieta-Echezarreta
authors.affiliation: Department A of Internal Medicine, Hospital Complex of Navarra, Irunlarrea 6, 31008 Pamplona, Spain.
authors.forename: Sara
authors.initials: S
authors.lastname: Pérez-Ricarte
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis / Q000401:mortality*; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Biomarcadores; Biomarkers; N-terminal ProB-type natriuretic peptide; Prohormona N-terminal del péptido natriurético cerebral; Pulmonary embolism; Riesgo de mortalidad; Risk of death; Tromboembolismo pulmonar