• Martin Langer, Mathias Forkmann, Utz Richter, Anne-Kathrin Tausche, Krunoslav Sveric, Marian Christoph, Karim Ibrahim, Michael Günther, Steffen Kolschmann, Alessandra Boscheri, Peggy Barthel, Ruth H Strasser, and Carsten Wunderlich.
• University of Technology Dresden, Department of Cardiology, Medical Clinic, Fetscherstr, 76, Dresden 01307, Germany.
• J Crit Care. 2016 Oct 1; 35: 174-9.

BackgroundRisk assessments of hemodynamically stable patients with pulmonary embolisms (PE) remain challenging. In this context heart-type fatty acid-binding protein (H-FABP), creatine kinase isoenzyme MB (CK-MB), and troponin I (TnI) may hold prognostic utility for patients with pulmonary embolism.MethodsWe included 161 consecutive normotensive (systolic blood pressure above 90 mm Hg) patients with confirmed PE to study the combined utility of echocardiographic signs of right ventricular dysfunction and several biomarkers (TnI, CK-MB, H-FABP). The primary endpoint was defined as death within 30 days after admission to the hospital.ResultsElevated biomarkers were measured in 26 patients (16.1%) for HFABP, in 66 (41%) for TnI and in 41 (25.5%) for CK-MB. Echocardiography revealed right ventricular dysfunction (RVD) in 99 (61.5%) patients. Overall, 16 patients (9.9%) died within the study period. In the H-FABP positive group 15 (57.7%) patients died compared to 13 (19.7%) patients in the TnI positive group and 15 (37.5%) patients in the CK-MB positive group (H-FABP positive vs TnI positive patients, P< .001; H-FABP positive vs CK-MB positive patients P= .13; CK-MB positive vs TnI positive patients P= .07). All elevated biomarkers correlated with the primary endpoint with H-FABP being strongly, CK-MB intermediately and TnI weakly associated with short term death (H-FABP r= 0.701, P< .001; CK-MB r= 0.486, P< .001; TnI r= 0.272, P= .001). In multivariate logistic regression analysis, a positive H-FABP test (OR 27.1, 95% CI 2.1-352.3, P= .001), elevated CK-MB levels (OR 5.3, 95% CI 1.3-23.3, P= .002) and a low systolic blood pressure on admission (OR 0.8, 95% CI 0.8-0.9, P< .001) emerged as independent predictors of 30-day mortality.ConclusionsBoth H-FABP and CK-MB are associated with short term mortality in normotensive PE patients and could be advantageous for risk stratification in this intermediate risk group.Copyright © 2016 Elsevier Inc. All rights reserved.

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