title: Cardiac biomarkers and clinical scores for risk stratification in elderly patients with non-high-risk pulmonary embolism.
abstract: OBJECTIVE
  To determine the prognostic accuracy of cardiac biomarkers alone and in combination with clinical scores in elderly patients with non-high-risk pulmonary embolism (PE).
  
  
  METHODS
  Ancillary analysis of a Swiss multicentre prospective cohort study.
  
  
  METHODS
  A total of 230 patients aged ≥65 years with non-high-risk PE.
  
  
  METHODS
  The study end-point was a composite of PE-related complications, defined as PE-related death, recurrent venous thromboembolism or major bleeding during a follow-up of 30 days. The prognostic accuracy of the Pulmonary Embolism Severity Index (PESI), the Geneva Prognostic Score (GPS), the precursor of brain natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) was determined using sensitivity, specificity, predictive values, receiver operating characteristic (ROC) curve analysis, logistic regression and reclassification statistics.
  
  
  RESULTS
  The overall complication rate during follow-up was 8.7%. hs-cTnT achieved the highest prognostic accuracy [area under the ROC curve: 0.75, 95% confidence interval (CI): 0.63-0.86, P < 0.001). At the predefined cut-off values, the negative predictive values of the biomarkers were above 95%. For levels above the cut-off, the risk of complications increased fivefold for hs-cTnT [odds ratio (OR): 5.22, 95% CI: 1.49-18.25] and 14-fold for NT-proBNP (OR: 14.21, 95% CI: 1.73-116.93) after adjustment for both clinical scores and renal function. Reclassification statistics indicated that adding hs-cTnT to the GPS or the PESI significantly improved the prognostic accuracy of both clinical scores.
  
  
  CONCLUSIONS
  In elderly patients with nonmassive PE, NT-proBNP or hs-cTnT could be an adequate alternative to clinical scores for identifying low-risk individuals suitable for outpatient management.
authors.affiliation: Faculty of Medicine, Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospital, Geneva, Switzerland.
authors.forename: N
authors.initials: N
authors.lastname: Vuilleumier
authors.affiliation: Clinical Trials Unit (CTU) Bern, Department of Clinical Research and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Limacher
authors.affiliation: Division of General Internal Medicine, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Méan
authors.affiliation: Faculty of Medicine, Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospital, Geneva, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Choffat
authors.affiliation: Faculty of Medicine, Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospital, Geneva, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Lescuyer
authors.affiliation: Faculty of Medicine, Division of Angiology and Haemostasis, Geneva University Hospital, Geneva, Switzerland.
authors.forename: H
authors.initials: H
authors.lastname: Bounameaux
authors.affiliation: Division of General Internal Medicine, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: D
authors.initials: D
authors.lastname: Aujesky
authors.affiliation: Faculty of Medicine, Division of Angiology and Haemostasis, Geneva University Hospital, Geneva, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Righini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D045283:Natriuretic Agents / Q000097:blood*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013557:Switzerland; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D045283:Natriuretic Agents; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: NT-proBNP; aged; biochemical markers; prognosis; pulmonary embolism; troponin