title: Risk stratification in acute pulmonary embolism with heart-type fatty acid-binding protein: A meta-analysis.
abstract: OBJECTIVE
  Heart-type fatty acid-binding protein (H-FABP) has emerged as a new biomarker in risk stratification of patients with acute pulmonary embolism (PE). We performed a meta-analysis of studies in patients with acute PE to assess the prognostic value of elevated H-FABP for short-term adverse outcomes.
  
  
  METHODS
  Two independent reviewers systematically searched PubMed, EMBASE, and Cochrane Database until June 2014.
  
  
  METHODS
  Studies were searched using MeSH word "fatty acid-binding protein" and "pulmonary embolism." Prospective studies were included if those were done on patients with acute PE and if serum H-FABP assay was done.
  
  
  METHODS
  Relevant data on study design, year of publication, patient population, inclusion criteria, exclusion criteria, mean age, sex, type of H-FABP assay, cutoff of H-FABP used, and outcomes were extracted. The primary end point was 30-day complicated clinical course and PE-related mortality. The secondary end point was right ventricular dysfunction (RVD). A random-effects model was used to pool study results.
  
  
  RESULTS
  Nine studies, including 1680 patients, reported data on the 30-day complicated clinical course. Elevated H-FABP was significantly associated with the increased risk of 30-day complicated clinical course (odds ratio [OR], 17.67; 95% confidence interval [CI], 6.02-51.89; I(2) = 80%). Similarly, 6 studies, including 676 patients, reported 30-day mortality data. Elevated H-FABP was associated with increased risk of 30-day PE-related mortality (OR, 32.94; 95% CI, 8.80-123.21, I(2) = 53%). The risk of RVD was significantly higher in patients with elevated H-FABP as compared with patients with normal H-FABP (OR, 2.57; 95% CI, 1.05-6.33, I(2) = 57%). The prognostic sensitivity and specificity of H-FABP were 71% and 74% in predicting 30-day complicated clinical course and were 90% and 70% in predicting 30-day mortality.
  
  
  CONCLUSIONS
  This meta-analysis indicates that elevated H-FABP levels are associated with increased risk of 30-day complicated clinical course, mortality, and RVD.
authors.affiliation: The Wright Center for Graduate Medical Education, Scranton, PA; The Common Wealth Medical College, Scranton, PA. Electronic address: dr.anuragbajaj@gmail.com.
authors.forename: Anurag
authors.initials: A
authors.lastname: Bajaj
authors.affiliation: Zhengzhou University, Zhengzhou, China.
authors.forename: Parul
authors.initials: P
authors.lastname: Rathor
authors.affiliation: The Common Wealth Medical College, Scranton, PA.
authors.forename: Vishal
authors.initials: V
authors.lastname: Sehgal
authors.affiliation: The Common Wealth Medical College, Scranton, PA.
authors.forename: Ajay
authors.initials: A
authors.lastname: Shetty
authors.affiliation: The Common Wealth Medical College, Scranton, PA.
authors.forename: Besher
authors.initials: B
authors.lastname: Kabak
authors.affiliation: Geisinger Medical Center, Scranton, PA.
authors.forename: Srikanth
authors.initials: S
authors.lastname: Hosur
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000401:mortality; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000401:mortality; D055815:Young Adult
chemical_list: D015415:Biomarkers; C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins
keywords: Heart-type fatty acid–binding protein; Mortality; Pulmonary embolism; Right ventricular dysfunction