Brain-type natriuretic peptide levels in the prediction of adverse outcome in patients with pulmonary embolism - A systematic review and meta-analysis
Brain-type natriuretic peptide levels in the prediction of adverse outcome in patients with pulmonary embolism - A systematic review and meta-analysis
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DOI：
10.1164/rccm.200803-459oc
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发表时间：
2008-08-15
影响因子：
24.7
通讯作者：
Huisman, Menno V.
中科院分区：
文献类型：
--
作者：
Klok, Frederikus A.;Mos, Inge C. M.;Huisman, Menno V.
基本原理：脑型利钠肽（BNP）升高在鉴别急性肺栓塞患者不良临床结局风险中的潜在作用尚未完全确定。目的：我们评估BNP或N末端BNP前体升高与急性肺栓塞患者预后的关系。（NT-pro-BNP）水平与肺栓塞患者的临床结局。从Medline和EMBASE中提取报告肺栓塞和BNP或NT-pro-BNP水平升高患者不良结局风险的研究文章。提取了研究设计、患者和检测特征以及临床结局的相关信息。主要终点是总死亡率和预定义的不良临床事件的复合结局。测量和主要结果：数据来自13项研究。在51%（576/1，132）的患者中，BNP或NT-pro-BNP水平升高。在亚群中进行了不同的分析。BNP或NT-pro-BNP水平升高与右心功能不全显著相关（P < 0.001）。BNP或NT-pro-BNP浓度高的患者发生复杂住院病程（比值比[OR]，6.8; 95%置信区间[CI]，4.4-10）和30天死亡率（OR，7.6; 95% CI，3.4-17）的风险更高。高NT-pro-BNP患者有10%的死亡风险（68/ 671; 95%CI，8.0-13%），而23%（209/909; 95%CI，20-26%）有不良的临床outcome.Conclusions：高浓度的BNIP区分肺栓塞患者在较高的风险复杂的住院过程和低BNP水平的死亡。然而，单独增加BNP或NT-pro-BNP浓度并不能证明更具侵入性的治疗方案是合理的。
Rationale: The potential role of elevated brain-type natriuretic peptides (BNP) in the differentiation of patients suffering from acute pulmonary embolism at risk for adverse clinical outcome has not been fully established.Objectives: We evaluated the relation between elevated BNP or N-terminal-pro-BNP (NT-pro-BNP) levels and clinical outcome in patients with pulmonary embolism.Methods: Articles reporting on studies that evaluated the risk of adverse outcome in patients with pulmonary embolism and elevated BNP or NT-pro-BNP levels were abstracted from Medline and EMBASE. Information on study design, patient and assay characteristics, and clinical outcome was extracted. Primary endpoints were overall mortality and predefined composite outcome of adverse clinical events.Measurements and Main Results: Data from 13 studies were included. In 51% (576/1,132) of the patients, BNP or NT-pro-BNP levels were increased. The different analyses were performed in subpopulations. Elevated levels of BNP or NT-pro-BNP were significantly associated with right ventricular dysfunction (P < 0.001). Patients with high BNP or NT-pro-BNP concentration were at higher risk of complicated in-hospital course (odds ratio [OR], 6.8; 95% confidence interval [CI], 4.4-10) and 30-day mortality (OR, 7.6; 95% CI, 3.4-17). Patients with a high NT-pro-BNP had a 10% risk of dying (68/ 671; 95% CI, 8.0-13%), whereas 23% (209/909; 95% CI, 20-26%) had an adverse clinical outcome.Conclusions: High concentrations of BNIP distinguish patients with pulmonary embolism at higher risk of complicated in-hospital course and death from those with low BNP levels. Increased BNP or NT-pro-BNP concentrations alone, however, do not justify more invasive treatment regimens.