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Published ahead of print on June 12, 2008, doi:10.1164/rccm.200803-459OC

Am. J. Respir. Crit. Care Med., Volume 178, Number 4, August 2008, 425-430

A more recent version of this article appeared on August 15, 2008
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Submitted on March 25, 2008
Accepted on June 12, 2008

BNP Levels in the Prediction of Adverse Outcome in Patients with Pulmonary Embolism: A Meta-analysis

Frederikus A Klok1, Inge CM Mos1, and Menno V Huisman1*

1 Section of Vascular Medicine, Department of General Internal Medicine - Endocrinology, LUMC, Leiden, The Netherlands

* To whom correspondence should be addressed. E-mail: M.V.Huisman{at}LUMC.nl.

Rationale: The potential role of elevated B-type natriuretic peptides in the differentiation of patients suffering from acute pulmonary embolism at risk for adverse clinical outcome has not been fully established. Objectives. We evaluated the relation between elevated (NT-pro-)BNP levels and clinical outcome in patients with pulmonary embolism. Methods: Articles reporting on studies that evaluated the risk of adverse outcome in patients with pulmonary embolism and elevated (NT-pro-)BNP levels were abstracted from Medline and EMBASE. Information on study design, patient- and assay characteristics and clinical outcome was extracted. Primary endpoints were overall mortality and pre-defined composite outcome of adverse clinical events. Measurements and Main Results: Data from 13 studies were included. In 51% (576/1132) of the patients (NT-pro-)BNP levels were increased. The different analyses were performed in subpopulations. Elevated levels of (NT-pro-)BNP were significantly associated with right ventricular dysfunction (p<0.001). Patients with high (NT-pro-)BNP concentration were at higher risk of complicated in-hospital course (OR 6.8, 95%CI 4.4-10) and 30-day mortality (OR 7.6, 95%CI 3.4-17). Patients with a high (NT-pro-)BNP had a 10% risk of dying (68/671, 95%CI 8.0-13) while 23% (209/909, 95%CI 20-26) had an adverse clinical outcome. Conclusions: High concentrations of BNP distinguish patients with pulmonary embolism at higher risk of complicated in-hospital course and death from those with low BNP levels. Increased (NT-pro-)BNP concentrations alone however do not justify more invasive treatment regimens.
Key words: Venous thromboembolism, BNP, right ventricular dysfunction, mortality, complicated clinical course




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