Derivation and Validation of Multimarker Prognostication for Normotensive Patients with Acute Symptomatic Pulmonary Embolism.
Am J Respir Crit Care Med. 2014 Jan 28;
Authors: Jiménez D, Kopecna D, Tapson V, Briese B, Schreiber D, Lobo JL, Monreal M, Aujesky D, Sanchez O, Meyer G, Konstantinides S, Yusen RD, the PROTECT investigators
Rationale: Not all patients with acute pulmonary embolism (PE) have a high risk of an adverse short-term outcome. Objectives: This prospective cohort study aimed to develop a multimarker prognostic model that accurately classifies normotensive patients with PE into low and high categories of risk of adverse medical outcomes. Methods: The study enrolled 848 outpatients from the PROTECT study (derivation cohort), and 529 patients from the PREP study (validation cohort). Investigators assessed study participants for a 30-day complicated course, defined as death from any cause, haemodynamic collapse, and/or adjudicated recurrent PE. Measurements and Main Results: A complicated course occurred in 63 (7.4%) of the 848 normotensive patients with acute symptomatic PE in the derivation cohort, and in 24 patients (4.5%) in the validation cohort. The final model included the simplified Pulmonary Embolism Severity Index (sPESI), cardiac troponin I (cTnI), brain natriuretic peptide (BNP), and lower limb ultrasound testing (CCUS). The model performed similarly in the derivation (c-index of 0.75) and validation (c-index of 0.85) cohorts. The combination of the sPESI and BNP testing showed a negative predictive value for a complicated course of 99.1% and 100% in the derivation and validation cohorts, respectively. The combination of all modalities had a positive predictive value for the prediction of a complicated course of 25.8% in the derivation cohort and 21.2% in the validation cohort. Conclusions: For normotensive patients that have acute PE, we derived and validated a multimarker model that predicts all-cause mortality, haemodynamic collapse, and/or recurrent PE within the following 30 days.
PMID: 24471575 [PubMed - as supplied by publisher]