RT Journal Article
SR Electronic
T1 Age-adjusted high-sensitivity troponin T cut-off value for risk stratification of pulmonary embolism
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1323
OP 1331
DO 10.1183/09031936.00174514
VO 45
IS 5
A1 Kaeberich, Anja
A1 Seeber, Valerie
A1 Jiménez, David
A1 Kostrubiec, Maciej
A1 Dellas, Claudia
A1 Hasenfuß, Gerd
A1 Giannitsis, Evangelos
A1 Pruszczyk, Piotr
A1 Konstantinides, Stavros
A1 Lankeit, Mareike
YR 2015
UL http://erj.ersjournals.com/content/45/5/1323.abstract
AB High-sensitivity troponin T (hsTnT) helps in identifying pulmonary embolism patients at low risk of an adverse outcome. In 682 normotensive pulmonary embolism patients we investigate whether an optimised hsTnT cut-off value and adjustment for age improve the identification of patients at elevated risk. Overall, 25 (3.7%) patients had an adverse 30-day outcome. The established hsTnT cut-off value of 14 pg·mL−1 retained its high prognostic value (OR (95% CI) 16.64 (2.24–123.74); p=0.006) compared with the cut-off value of 33 pg·mL−1 calculated by receiver operating characteristic analysis (7.14 (2.64–19.26); p<0.001). In elderly (aged ≥75 years) patients, an age-optimised hsTnT cut-off value of 45 pg·mL−1 but not the established cut-off value of 14 pg·mL−1 predicted an adverse outcome. An age-adjusted hsTnT cut-off value (≥14 pg·mL−1 for patients aged <75 years and ≥45 pg·mL−1 for patients aged ≥75 years) provided additive and independent prognostic information on top of the simplified pulmonary embolism severity index (sPESI) and echocardiography (OR 4.56 (1.30–16.01); p=0.018, C-index=0.77). A three-step approach based on the sPESI, hsTnT and echocardiography identified 16.6% of all patients as being at higher risk (12.4% adverse outcome). Risk assessment of normotensive pulmonary embolism patients was improved by the introduction of an age-adjusted hsTnT cut-off value. A three-step approach helped identify patients at higher risk of an adverse outcome who might benefit from advanced therapy. Age-adjusted hsTnT cut-off values for risk stratification of pulmonary embolism provide additive prognostic information. http://ow.ly/FmcZl