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ERRATUM TO: Cardiac Troponins in Low-Risk Pulmonary Embolism Patients: A Systematic Review and Meta-Analysis
Omar S Darwish1, Abdullah Mahayni2, Mukti Patel3
1University of California, Irvine, UCI Medical Center, Orange, California, USA. odarwish@uci.edu.
Insights
Cardiac troponin levels in low-risk pulmonary embolism patients are assessed. Elevated troponin indicates a higher risk of mortality, while negative troponin suggests a lower risk, aiding clinical decisions.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Diagnostic Biomarkers
Background:
- Pulmonary embolism (PE) is a critical condition requiring accurate risk stratification.
- Cardiac troponins are established biomarkers for myocardial injury.
- Assessing the prognostic value of troponins in low-risk PE is crucial for guiding management.
Purpose of the Study:
- To systematically review and meta-analyze the diagnostic and prognostic accuracy of cardiac troponins in patients with low-risk pulmonary embolism.
- To determine the predictive value of troponin levels for all-cause mortality in this patient cohort.
Main Methods:
- Systematic review and meta-analysis of published studies.
- Inclusion of studies reporting troponin levels and clinical outcomes in low-risk PE patients.
- Pooled analysis of diagnostic performance metrics including positive and negative likelihood ratios (LRs), positive and negative predictive values (PPVs and NPVs), and odds ratios (ORs).
Main Results:
- The pooled positive likelihood ratio (LR) for all-cause mortality was 2.04 (95% CI, 1.53 to 2.72), and the negative LR was 0.72 (95% CI, 0.37 to 1.40).
- In the pooled data, 33% of patients tested positive for troponin, and the overall mortality was 1.2%.
- The overall negative predictive value (NPV) was approximately 1, indicating high reliability in ruling out mortality. The overall positive predictive values (PPVs) were low, ranging from 0 to 0.60.
Conclusions:
- Cardiac troponin testing demonstrates prognostic value in low-risk pulmonary embolism patients.
- A negative troponin result is highly reliable for excluding mortality (NPV ≈ 1).
- Elevated troponin levels are associated with an increased risk of all-cause mortality, though with low positive predictive value.
Abstract:
The authors would like to make the following corrections to their manuscript, Cardiac Troponins in Low-Risk Pulmonary Embolism Patients: A Systematic Review and Meta-Analysis (doi: 10.12788/jhm.2961), published online first April 25, 2018 (all corrections in bold): The last sentence of the results section in the abstract should read: The pooled likelihood ratios (LRs) for all-cause mortality were positive LR 2.04 [95% CI, 1.53 to 2.72] and negative LR 0.72 [95% CI, 0.37 to 1.40]. In the "All studies pooled" of the last row of Table 2, Tn+ is corrected to 463. On page E5, the first paragraph in the "Outcomes of Studies with Corresponding Troponin+ and Troponin-" section beginning with the fifth sentence should read as follows): "In the pooled data, 463 (67%) patients tested negative for troponin and 228 (33%) tested positive. The overall mortality (from sensitivity analysis) including in-hospital, 30-day, and 90-day mortalities was 1.2%. The NPVs for all individual studies and the overall NPV are 1 or approximately 1. The overall PPVs and by study were low, ranging from 0 to 0.60. The PLRs and NLRs were not estimated for an outcome within an individual study if none of the patients experienced the outcome. When outcomes were only observed among troponin-negative patients, such as in the study of Moore (2009) who used 30-day all-cause mortality, the PLR had a value of zero. When outcomes were only observed among troponin-positive patients, as for 30-day all-cause mortality in the Hakemi9(2015), Lauque10 (2014), and Lankeit16 (2011) studies, the NLR had a value of zero. For zero cells, a continuity correction of 0.5 was applied. The pooled likelihood ratios (LRs) for all-cause mortality were positive LR 2.04 [95% CI, 1.53 to 2.72] and negative LR 0.72 [95% CI, 0.37 to 1.40]. The OR for all-cause mortality was 4.79 [95% CI 1.11 to 20.68, P = .0357].
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