Risk stratification in acute pulmonary embolism with heart-type fatty acid–binding protein: A meta-analysis

Abstract

ObjectiveHeart-type fatty acid–binding protein (H-FABP) has emerged as a new biomarker in risk stratification of patients with acute pulmonary embolism (PE). We performed a meta-analysis of studies in patients with acute PE to assess the prognostic value of elevated H-FABP for short-term adverse outcomes. Data sourceTwo independent reviewers systematically searched PubMed, EMBASE, and Cochrane Database until June 2014. Data SelectionStudies were searched using MeSH word “fatty acid–binding protein” and “pulmonary embolism.” Prospective studies were included if those were done on patients with acute PE and if serum H-FABP assay was done. Data ExtractionRelevant data on study design, year of publication, patient population, inclusion criteria, exclusion criteria, mean age, sex, type of H-FABP assay, cutoff of H-FABP used, and outcomes were extracted. The primary end point was 30-day complicated clinical course and PE-related mortality. The secondary end point was right ventricular dysfunction (RVD). A random-effects model was used to pool study results. Data SynthesisNine studies, including 1680 patients, reported data on the 30-day complicated clinical course. Elevated H-FABP was significantly associated with the increased risk of 30-day complicated clinical course (odds ratio [OR], 17.67; 95% confidence interval [CI], 6.02-51.89; I2 = 80%). Similarly, 6 studies, including 676 patients, reported 30-day mortality data. Elevated H-FABP was associated with increased risk of 30-day PE-related mortality (OR, 32.94; 95% CI, 8.80-123.21, I2 = 53%). The risk of RVD was significantly higher in patients with elevated H-FABP as compared with patients with normal H-FABP (OR, 2.57; 95% CI, 1.05-6.33, I2 = 57%). The prognostic sensitivity and specificity of H-FABP were 71% and 74% in predicting 30-day complicated clinical course and were 90% and 70% in predicting 30-day mortality. ConclusionThis meta-analysis indicates that elevated H-FABP levels are associated with increased risk of 30-day complicated clinical course, mortality, and RVD.