Value of Cardiac Biomarkers for Predicting Hypotension in Non-high-risk Patients with Acute Pulmonary Embolism

Lee, Jong Seung; Jung, Sang Ku; Sohn, Chang Hwan; Seo, Dong Woo; Lee, Jae Ho; Oh, Bum Jin; Kim, Won Young; Lim, Kyoung Soo

Abstract

PURPOSE
Recent and numerous studies have indicated that cardiac biomarker elevation during acute pulmonary embolism (PE) predicts in-hospital death. However, the role of cardiac biomarkers for predicting the occurrence of hypotension is unknown. The aim of the present study was to evaluate whether increased levels of cardiac biomarkers can predict the occurrence of hypotension (sytolic blood pressure (SBP) <90 mmHg) within 24 hours in non-high-risk patients with acute PE.
METHODS
Study subjects included all consecutive patients with acute PE, as diagnosed by chest computed tomographic angiography, in the emergency department (ED) from January 2009 through December 2011. All patients underwent tests for troponinI (TnI), creatinine kinase-MB isoenzyme (CK-MB), and brain natriuretic peptide (BNP) levels upon ED admission and were divided into two groups based on the occurrence of hypotension within 24 hours.
RESULTS
Out of 196 stable patients with acute PE admitted to the ED during the study period, 154 patients were included. Within 24 hours of hospitalization, 13 (8.4%) patients developed hypotension. The mean values for serum TnI, CK-MB, and BNP were significantly higher in patients who developed hypotension than in patients who did not. The TnI value was the most accurate biomarker for predicting the occurrence of hypotension. Moreover, elevated levels of cTnI (>0.05 ng/mL) upon admission were an independent predictor for developing hypotension within 24 hours in patients with stable acute PE at the time of ED admission (odds ratio 11.0, 95% confidence interval (CI) 2.8-43.8, p=0.00).
CONCLUSION
In stable patients with acute PE, an elevated TnI can predict the in-hospital development of hypotension within 24 hours. This finding is valuable for selecting patients who might benefit from intensive clinical surveillance and escalated treatment.