High-sensitivity troponin T assay identifies early discharge PE patients
MedWire News: A high-sensitivity troponin T (hsTnT) assay accurately identifies patients with low-risk pulmonary embolism (PE), and may be helpful for selecting possible candidates for early discharge and home treatment, say researchers.
Stavros Konstantinides (Democritus University of Thrace, Alexandroupolis, Greece) and colleagues explain that current guidelines emphasize the importance of early risk stratification of patients with acute PE to allow assessment of the individual prognosis and guide therapeutic decision-making.
In a previous derivation study, the researchers found that a hsTnT cutoff value of 14 pg/mL may be associated with a high prognostic sensitivity and negative predictive value (NPV) for an adverse 30-day outcome after acute PE.
In the present study, the researchers externally validated the predictive value of the hsTnT assay, and compared it with that of the simplified Pulmonary Embolism Severity Index (sPESI), another prognostic tool for patients with PE.
They prospectively examined 526 normotensive patients with acute PE. Of these, 312 (59.3%) had a hsTnT levels above 14 pg/mL (median 19.3 pg/mL), while 328 (62.4%) were assigned to the sPESI high-risk category (≥1 point).
The researchers report that 31 (5.9%) patients had an adverse 30-day outcome, defined as death from any cause, or a need for intravenous catecholamine administration, endotracheal intubation, or cardiopulmonary resuscitation.
Patients with an adverse 30-day outcome had significantly higher median hsTnT levels than those with a favorable course, at 57.7 versus 18.0 pg/mL.
Receiver operating characteristic analysis showed that, at a cutoff of 14 pg/mL, the hsTnT assay has a prognostic sensitivity of 87% and a NPV of 98%. The sPESI was also associated with a high prognostic sensitivity (94%) and NPV (99%).
Furthermore, when hsTnT was used in combination with sPESI, the sensitivity and NPV were both 100%
Having a hsTnT level at or above 14 pg/mL was significantly and independently associated with a 3.1-fold increased risk for death or complications within 30 days, while a sPESI of 1 point or more was associated with a 6.6-fold increased risk.
Konstantinides and co-authors comment that "the consistent findings in both our derivation cohort and in the present validation study indicate that patients with hsTnT levels below 14 pg/mL on admission have a favorable short-term prognosis.
"They thus support the applicability of hsTnT for a careful selection of low-risk patients, in particular, when the test is combined with the sPESI," the team concludes in the journal Circulation.
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By Laura Dean