title: Prognostic Value of Biomarkers in Acute Non-massive Pulmonary Embolism: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  Various biomarkers have been evaluated to risk stratify patients with acute pulmonary embolism (PE). We aimed to summarize the available evidence to compare the prognostic value of three most widely studied biomarkers in normotensive patients with acute PE.
  
  
  METHODS
  A systematic literature review of database, including Pubmed, EMBASE and Cochrane, was done. Studies were included if those were done on patients with acute PE and serum troponin or brain natriuretic peptide and N-terminal proBNP (BNP/NT-proBNP) or Heart-type fatty acid-binding protein (H-FABP) assay was done. The primary end point was short-term all-cause mortality. The secondary end points were PE-related mortality and serious adverse events.
  
  
  RESULTS
  All three biomarkers were significantly associated with increased risk for short-term all-cause mortality, PE-related mortality and serious adverse events. All-cause mortality: troponin [odds ratio (OR) 4.80; 95% CI 3.25-7.08, I(2) = 54%], BNP or NT-proBNP (OR 7.98; 95% CI 4.34-14.67, I(2) = 0%); PE-related mortality: troponin (OR 3.80; 95% CI 2.74-5.27, I(2) = 0%), BNP or NT-proBNP (OR 7.57; 95% CI 2.89-19.81, I (2) = 0%) and H-FABP (OR 25.97; 95% CI 6.63-101.66, I(2) = 40%). H-FABP has the lowest negative likelihood ratio (NLR) of 0.17 for mortality followed by high-sensitive cardiac troponin T (hs-cTnT) with NLR of 0.21.
  
  
  CONCLUSIONS
  None of the biomarker identifies a subgroup of patients who can be managed as an outpatient versus patients who may get benefit from thrombolytics with certainty; however, H-FABP and hs-cTnT showed some promising results and should be investigated further.
authors.affiliation: The Wright Center for Graduate Medical Education, 501 Madison Avenue, Scranton, PA, 18510, USA. dr.anuragbajaj@gmail.com.
authors.forename: Anurag
authors.initials: A
authors.lastname: Bajaj
authors.affiliation: Zhengzhou University, 100 Ke Xue Da Dao, Zhongyuan, Zhengzhou, Henan, China. parul_25d@yahoo.co.in.
authors.forename: Parul
authors.initials: P
authors.lastname: Rathor
authors.affiliation: The Common Wealth Medical College, 525 Pine Street, Scranton, PA, USA. sehgalvishal@hotmail.com.
authors.forename: Vishal
authors.initials: V
authors.lastname: Sehgal
authors.affiliation: The Common Wealth Medical College, 525 Pine Street, Scranton, PA, USA. besherkabak@yahoo.com.
authors.forename: Besher
authors.initials: B
authors.lastname: Kabak
authors.affiliation: The Common Wealth Medical College, 525 Pine Street, Scranton, PA, USA. ajayshetty@comcast.net.
authors.forename: Ajay
authors.initials: A
authors.lastname: Shetty
authors.affiliation: The Wright Center for Graduate Medical Education, 501 Madison Avenue, Scranton, PA, 18510, USA. almasalmeho@thewrightcenter.org.
authors.forename: Ossama
authors.initials: O
authors.lastname: Al Masalmeh
authors.affiliation: Critical Care Division, Geisinger Community Medical Center, 1800 Mulberry Street, Scranton, USA. shosur@geisinger.edu.
authors.forename: Srikanth
authors.initials: S
authors.lastname: Hosur
mesh_terms: D000208:Acute Disease; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011655:Pulmonary Embolism / Q000097:blood* / Q000401:mortality*; D014336:Troponin / Q000097:blood*
chemical_list: D015415:Biomarkers; C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins; D010446:Peptide Fragments; D014336:Troponin; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Meta-analysis; Mortality; Prognosis; Pulmonary embolism