Performance of D-dimer, cardiac troponin T, C-reactive protein and NT-proBNP in prediction of long-term mortality in patients with suspected pulmonary embolism

Abstract

Abstract Background Pulmonary embolism (PE) is a common and potentially life-threatening condition requiring emergent diagnostic work-up. Despite wide use of biomarkers, little is known how they predict long-term prognosis of patients evaluated for suspected PE. Methods We sought to assess the predictive performance of NT-proBNP, C-reactive protein (CRP), D-dimer (FIDD) and cardiac troponin T (cTnT) in patients who underwent computed tomography pulmonary angiography (CTPA) for clinical suspicion of PE. The analysis involved 1001 patients, with 222 (22.2%) receiving a PE diagnosis at index imaging. Mean age of patients with and without PE were 65.0 ± 17.1 and 64.5 ± 17.7 years, respectively. Median follow-up time was 3.9 years [IQR 2.9-4.9]. Results Mortality was relatively high both among patients with and without documented PE (24.8% vs. 31.7%, p=0.047). In patients with PE, only elevated NT-proBNP>1000 ng/L and CRP>50 mg/L levels at hospital admission were associated with higher mortality in an adjusted Cox regression model, but ROC analysis showed no improved prediction compared to clinical variables. Among patients without PE, elevated NT-proBNP>1000 ng/L, CRP>10 mg/L, cTnT>50 ng/L and FIDD>1.0 mg/L all predicted mortality. In an ROC analysis among patients without PE, models including NT-proBNP, cTnT or CRP provided improved predictive performance. Conclusions Patients evaluated for clinical suspicion of PE have high long-term mortality. Commonly used biomarkers provide long-term prognostic value in patients without PE. Given the relatively young age, it is vital to identify these high-risk patients, and perform differential diagnosis work-up for alternative life-threatening conditions, and manage them as appropriate.