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Journal of The Korean Society of Emergency Medicine 2017;28(1): 71-77. |
| 응급실에서 채취한 심근표지자는 급성 폐색전증 환자의 예후를 예측하는데 도움이 되는가? |
| 김은백1, 임용수1, 장연식1, 김진주1, 박용주2 |
1가천대학교 길병원 응급의학과
2서울대학교병원 응급의학과 |
| Are the Cardiac Biomarkers in the Emergency Room Sufficient to Predict Adverse Events in Acute Pulmonary Embolism? |
| Eunbaek Kim1, Yongsu Lim1, Yeonsik Jang1, Jinjoo Kim1, Yong Joo Park2 |
1Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, Korea
2Seoul National University Hospital, Seoul, Korea |
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Received: September 21, 2016; Revised: September 22, 2016 Accepted: October 10, 2016. Published online: February 28, 2017. |
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| ABSTRACT |
Purpose:
The aim of this study is to determine whether cardiac biomarkers, such as N-terminal-proB-type natriuretic peptide (NT-proBNP), are good predictors of adverse events in acute pulmonary embolism (APE).
Method:
We conducted a retrospective analysis of patients with APE, which was confirmed by a computed tomography in the emergency room. Patients were divided into 2 groups: the major adverse event (MAE) group and the no-MAE group. MAE was defined as one of the following occurrences: in-hospital-death, cardiopulmonary resuscitation, mechanical ventilation, vasopressors, thrombolysis, or surgical embolectomy. Blood samples were obtained during the first hour of presentation to the emergency room.
Results:
A total of 90 patients were included in this study. Twenty-seven patients had MAE. According to the univariate analysis, NT-proBNP, troponin I, and D-dimer plasma levels were significantly higher in the MAE group than in the noMAE group (919.8 vs. 2,131.0 ng/mL, p=0.032; 0.091 vs. 0.172 ng/mL, p=0.037; 2.43 vs. 3.74 ng/mL, p=0.049, respectively). However, according to the multivariate logistic regression, NT-proBNP was not independently associated with MAE in APE (odds ratio, 1.01; 95% confidence interval, 1.00-1.01). Conversely, troponin I was independently associated with MAE (odds ratio, 1.09; 95% confidence interval, 0.99-1.18). The NT-proBNP plasma level was not significantly different between the right ventricular dysfunction (RVD) group and the no-RVD group (p=0.178).
Conclusion:
The NT-proBNP level, unlike the troponin I level, in the emergency room was not identified as an independent predictor of MAE in acute pulmonary embolism. Further studies of large-scale with controlled timing of blood sampling and echocardiography are required. |
| Key words:
Pulmonary embolism, Natriuretic peptide, Troponin I, Adverse |
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