Prospective Evaluation of Serial Biomarkers in Patients With Intermediate High Risk Acute Pulmonary Embolism: A...

Patients diagnosed with intermediate high-risk pulmonary embolism (IHRPE) are at significant risk for clinical deterioration during hospitalization; however, clinical tools to identify which patients will worsen are imprecise. We designed a proof-of-concept, single-center prospective study to assess IHRPE patients (using 2019 ESC criteria), measuring blood concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP), troponin T (TnT), uric acid, and plasma lactate serially during the first 72 h to better understand their kinetics and associations with in-hospital adverse clinical events. Twenty subjects (mean age 62.0 ± 12.6 years) diagnosed by computed tomography angiogram were enrolled. Central pulmonary embolism was seen in 18/20, and lower extremity deep vein thrombosis in 14/20. On presentation, the mean Bova and PESI scores were 5 ± 0.7 and 105 ± 25.2, respectively. At baseline, TnT was elevated in 20/20, NT-proBNP in 18/20, uric acid in 10/20, and lactate in 8/20 subjects. Clinical outcomes included ICU admission in 7/20, clinical deterioration in 10/20, and death in 2/20. Clinical deterioration was associated with persistent elevations of TnT, NT-proBNP, uric acid and lactate (all p < 0.05). The NT-proBNP time from baseline to peak concentration was highly associated with clinical deterioration (ROC AUC = 0.82 [95% CI: 0.62-0.97, p < 0.01, RR = 2.8 at 24 h). The baseline PESI score ROC AUC for clinical deterioration was 0.75 (95% CI: 0.515-0.952, p = NS). Persistently elevated biomarkers show an association with in-hospital adverse clinical events in IHRPE and warrant further study to assist clinical management.