Value Of Simplified Pulmonary Embolism Severity Index And The Joint Detection Of Biomarkers In Evaluating Pulmonary Embolism Severity And Prognosis

Objective: To evaluate the value of simplified Pulmonary Embolism SeverityIndex, Brain Natriuretic Peptide and high-sensitivity troponin I in predicting theshort-term and long-term prognosis of patients with acute pulmonary embolism.Research the value of joint detection in risk stratification and integrated management ofpulmonary embolism.Methods: We collected data and files of162consecutive patients with acutepulmonary embolism in The First Affiliated Hospital of Dalian Medical University fromJanuary of2010to September of2012. We set nosocomial death, shock, mechanicalventilation and cardiopulmonary resuscitation as primary endpoint and death within38months as secondary endpoint. And then we retrospectively analyzed the correlationbetween simplified pulmonary embolism severity index, D-dimer, high-sensitivitytroponin I, Brain Natriuretic Peptide, right ventricular/left ventricular diameter ratio inechocardiography or CT and Pulmonary artery obstruction index and primary andsecondary endpoint in overall cohort and hemodynamically stable subgroup respectively.We screened the best indicators and analyzed the correlation between these indicatorsand implication of joint detection.Results: Brain Natriuretic Peptide, high-sensitivity troponin I and simplifiedPulmonary Embolism Severity Index are independent predictors in multivariateregression of the primary endpoint in overall cohort. Their best cut-off value, area underROC curve, risk odds ratio are514pg/ml,0.87(95%CI：0.77-0.97),8.16(P=0.031)；0.125ug/L,0.91(95%CI：0.85-0.96),6.09(P=0.049)and0,0.78(95%CI：0.68-0.87),14.07(P=0.024) respectively. Only Brain Natriuretic Peptide and simplifiedPulmonary Embolism Severity Index are independent predictors in multivariateregression of the primary endpoint in hemodynamically stable subgroup. The area under ROC curve and risk odds ratios of them are0.84(95%CI:0.67-0.99),0.74(95%CI:0.59-0.88) and20.59(P=0.028),8.59(P=0.048) respectively. Only simplifiedPulmonary Embolism Severity Index is an independent risk factor in COX regression ofsecondary endpoint (interquartile:269days-843days) for overall cohort andhemodynamically stable subgroup. The positive predictive value, negative predictivevalue, risk odds ratios are35.8%,97.9%,16.8(95%CI：3.6-78.28)and34.5%,97.9%,14.15(95%CI：3.07-65.15)respectively in two cohorts. The combination of BrainNatriuretic Peptide≥514pg/ml and high-sensitivity troponin I≥0.1ug/L furtherimproves the positive predictive value (44.4%), while the negative predictive value isunaffected(97.8%). The nosocomial adverse event rates are44.4%,6.9%,0.9%respectively in both positive,single-positive and both negative subgroup inhemodynamically stable cohort. The odds ratio is35.2(95%CI：3.06-153.77) of thiskind of combination. It is superior to the combination of Brain Natriuretic Peptide andCT, the combination of Brain Natriuretic Peptide and echocardiography, and theinternal combination among imaging detections. There is no adverse event in patientswith low score of simplified Pulmonary Embolism Severity Index and single-positive ornegative combination of Brain Natriuretic Peptide and high-sensitivity troponin I.Conclusion:1.Simplified Pulmonary Embolism Severity Index can reflect overallrisk of pulmonary embolism and it has a high value in the evaluation of PulmonaryEmbolism prognosis, especially in long-term prognosis. It should be integrated into riskstratification stategy of pulmonary embolism.2.In the evaluation of short-term prognosis, biomarkers such as BrainNatriuretic Peptide and troponin are excellent indicators which have higher value thanechocardiography and CT. And the combination of Brain Natriuretic Peptide andtroponin can further improve the prognostic value.