Persistent NT-proBNP elevation in acute pulmonary embolism predicts early death

Clin Chim Acta. 2007 Jul;382(1-2):124-8. doi: 10.1016/j.cca.2007.04.010. Epub 2007 Apr 24.


Aims: Low levels of brain natriuretic peptides on admission identify low-risk patients with acute pulmonary embolism (APE) through their high NPV for mortality. However, increased natriuretic peptide values on admission are less helpful for identifying high-risk patients due to their low PPV. The aim of the study was to test whether the PPV for mortality can be improved by performing serial NT-proBNP measurements on admission, at 12 h, and at 24 h.

Methods and results: We prospectively included 113 consecutive patients with APE (mean age 63+/-18 years), of whom 10 had clinically massive APE. Thirty-day mortality was 15% (95% CI: 8%-22%). In survivors, median NT-proBNP levels decreased within 24 h from 1895 ng/L (range: 16-33,340) to 1007 ng/L (range: 9-33,243) (p<0.001). In non-survivors, median NT-proBNP levels at baseline (11,491 ng/L, range: 618-60,958) remained elevated at 24 h (8139 ng/L, range: 35-70,018; p=NS). The 30-day mortality rate in the group of 18 patients with NT-proBNP >7500 ng/L and less than 50% decrease of NT-proBNP within 24 h was 61% (95% CI: 39%-84%). PPV and NPV of NT-proBNP >7500 ng/L on admission and less than 50% decrease of NT-proBNP within 24 h were 61% and 94%, respectively.

Conclusion: Persistent elevation of plasma NT-proBNP levels within 24 h after APE diagnosis indicates ongoing right ventricular dysfunction with a poor prognosis. These critically ill patients may be candidates for rapid aggressive intervention, including thrombolysis, catheter thrombectomy, or surgical embolectomy.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Biomarkers / blood
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood*
  • Odds Ratio
  • Peptide Fragments / blood*
  • Poland / epidemiology
  • Prognosis
  • Prospective Studies
  • Pulmonary Embolism / blood*
  • Pulmonary Embolism / mortality*
  • ROC Curve
  • Ventricular Dysfunction, Right / blood


  • Biomarkers
  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain