A novel H-FABP assay and a fast prognostic score for risk assessment of normotensive pulmonary embolism

Thromb Haemost. 2014 May 5;111(5):996-1003. doi: 10.1160/TH13-08-0663. Epub 2014 Jan 30.


We tested whether heart-type fatty acid binding protein (H-FABP) measured by a fully-automated immunoturbidimetric assay in comparison to ELISA provides additive prognostic value in patients with pulmonary embolism (PE), and validated a fast prognostic score in comparison to the ESC risk prediction model and the simplified Pulmonary Embolism Severity Index (sPESI). We prospectively examined 271 normotensive patients with PE; of those, 20 (7%) had an adverse 30-day outcome. H-FABP levels determined by immunoturbidimetry were higher (median, 5.2 [IQR; 2.7-9.8] ng/ml) than those by ELISA (2.9 [1.1-5.4] ng/ml), but Bland-Altman plot demonstrated a good agreement of both assays. The area under the curve for H-FABP was greater for immunoturbidimetry than for ELISA (0.82 [0.74-0.91] vs 0.78 [0.68-0.89]; P=0.039). H-FABP measured by immunoturbidimetry (but not by ELISA) provided additive prognostic information to other predictors of 30-day outcome (OR, 12.4 [95% CI, 1.6-97.6]; P=0.017). When H-FABP determined by immunoturbidimetry was integrated into a novel prognostic score (H-FABP, Syncope, and Tachycardia; FAST score), the score provided additive prognostic information by multivariable analysis (OR, 14.2 [3.9-51.4]; p<0.001; c-index, 0.86) which were superior to information obtained by the ESC model (c-index, 0.62; net reclassification improvement (NRI), 0.39 [0.21-0.56]; P<0.001) or the sPESI (c-index, 0.68; NRI, 0.24 [0.05-0.43]; P=0.012). In conclusion, determination of H-FABP by immunoturbidimetry provides prognostic information superior to that of ELISA and, if integrated in the FAST score, appears more suitable to identify patients with an adverse 30-day outcome compared to the ESC model and sPESI.

Publication types

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

MeSH terms

  • Aged
  • Automation, Laboratory
  • Blood Pressure
  • Disease Progression
  • Enzyme-Linked Immunosorbent Assay
  • Fatty Acid Binding Protein 3
  • Fatty Acid-Binding Proteins / metabolism*
  • Female
  • Follow-Up Studies
  • Heart Arrest / diagnosis*
  • Heart Arrest / etiology
  • Heart Arrest / prevention & control
  • Humans
  • Male
  • Middle Aged
  • Nephelometry and Turbidimetry / methods*
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Pulmonary Embolism / complications
  • Pulmonary Embolism / diagnosis*
  • Pulmonary Embolism / mortality
  • Reproducibility of Results
  • Respiratory Insufficiency / diagnosis*
  • Respiratory Insufficiency / etiology
  • Respiratory Insufficiency / prevention & control
  • Risk
  • Risk Assessment
  • Severity of Illness Index
  • Survival Analysis


  • FABP3 protein, human
  • Fatty Acid Binding Protein 3
  • Fatty Acid-Binding Proteins