Prognostic value of troponins in acute pulmonary embolism - A meta-analysis
Prognostic value of troponins in acute pulmonary embolism - A meta-analysis
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DOI：
10.1161/circulationaha.106.680421
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发表时间：
2007-07-24
期刊：
影响因子：
37.8
通讯作者：
Agnelli, Giancarlo
中科院分区：
文献类型：
--
作者：
Becattini, Cecilia;Vedovati, Maria Cristina;Agnelli, Giancarlo
背景-血清肌钙蛋白水平升高是否能识别急性肺栓塞患者短期死亡或不良结局的高风险尚不明确。方法和结果-我们对急性肺栓塞患者的研究进行了荟萃分析，以评估肌钙蛋白水平升高对短期死亡和不良结局事件的预后价值（死亡和以下任何事件的复合事件：休克、需要溶栓、气管插管、儿茶酚胺输注、心肺复苏或复发性肺栓塞）。使用术语“肌钙蛋白”和“肺栓塞”对1998年1月至2006年11月的MEDLINE和EMBASE文献数据库进行了无限制检索。此外，还手动检索了综述文章和参考文献。如果队列研究使用了心脏特异性肌钙蛋白测定并报告了短期死亡或不良结局事件，则纳入队列研究。使用随机效应模型汇总研究结果;进行漏斗图检查以评估发表偏倚;使用I-2检验来检验异质性。分析中纳入了20项研究（1985例患者）的数据。总体而言，618例肌钙蛋白水平升高的患者中有122例死亡（19.7%; 95%置信区间[CI]，16.6 - 22.8），而1367例肌钙蛋白水平正常的患者中有51例死亡（3.7%; 95% CI，2.7 - 4.7）。肌钙蛋白水平升高与短期死亡率（比值比[OR]，5. 24; 95% CI，3. 28 - 8. 38）、肺栓塞导致的死亡（OR，9. 44; 95% CI，4. 14 - 21. 49）和不良结局事件（OR，7. 03; 95% CI，2. 42 - 20. 43）显著相关。在血流动力学稳定的患者亚组中，肌钙蛋白水平升高与高死亡率相关（OR，5.90; 95% CI，2.68 - 12.95）。结果是一致的肌钙蛋白I或T和前瞻性或回顾性study.Conclusions -肌钙蛋白水平升高识别急性肺栓塞患者在短期死亡和不良结局事件的高风险。
Background - Whether elevated serum troponin levels identify patients with acute pulmonary embolism at high risk of short-term mortality or adverse outcome is undefined.Methods and Results - We performed a meta-analysis of studies in patients with acute pulmonary embolism to assess the prognostic value of elevated troponin levels for short- term death and adverse outcome events (composite of death and any of the following: shock, need for thrombolysis, endotracheal intubation, catecholamine infusion, cardiopulmonary resuscitation, or recurrent pulmonary embolism). Unrestricted searches of MEDLINE and EMBASE bibliographic databases from January 1998 to November 2006 were performed using the terms "troponin" and "pulmonary embolism" Additionally, review articles and bibliographies were manually searched. Cohort studies were included if they had used cardiac-specific troponin assays and had reported on short-term death or adverse outcome events. A random-effects model was used to pool study results; funnel-plot inspection was done to evaluate publication bias; and I-2 testing was used to test for heterogeneity. Data from 20 studies ( 1985 patients) were included in the analysis. Overall, 122 of 618 patients with elevated troponin levels died (19.7%; 95% confidence interval [CI], 16.6 to 22.8) compared with 51 of 1367 with normal troponin levels (3.7%; 95% CI, 2.7 to 4.7). Elevated troponin levels were significantly associated with short- term mortality (odds ratio [OR], 5.24; 95% CI, 3.28 to 8.38), with death resulting from pulmonary embolism (OR, 9.44; 95% CI, 4.14 to 21.49), and with adverse outcome events (OR, 7.03; 95% CI, 2.42 to 20.43). Elevated troponin levels were associated with a high mortality in the subgroup of hemodynamically stable patients ( OR, 5.90; 95% CI, 2.68 to 12.95). Results were consistent for troponin I or T and prospective or retrospective studies.Conclusions - Elevated troponin levels identify patients with acute pulmonary embolism at high risk of short- term death and adverse outcome events.