응급실에서 채취한 심근표지자는 급성 폐색전증 환자의 예후를 예측하는데 도움이 되는가?Are the Cardiac Biomarkers in the Emergency Room Sufficient to Predict Adverse Events in Acute Pulmonary Embolism?
- Other Titles
- Are the Cardiac Biomarkers in the Emergency Room Sufficient to Predict Adverse Events in Acute Pulmonary Embolism?
- Authors
- 김은백; 임용수; 장연식; 김진주; 박용주
- Issue Date
- 2017
- Publisher
- 대한응급의학회
- Keywords
- Pulmonary embolism; Natriuretic peptide; Troponin I; Adverse
- Citation
- 대한응급의학회지, v.28, no.1, pp.71 - 77
- Journal Title
- 대한응급의학회지
- Volume
- 28
- Number
- 1
- Start Page
- 71
- End Page
- 77
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/7380
- ISSN
- 1226-4334
- 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).
Methods: 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 no- MAE 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.
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