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Importance of Biomarkers in Risk Stratification of Pulmonary Thromboembolism Patients
  1. Elif Babaoglu, MD*,
  2. H. Canan Hasanoglu, MD*,
  3. Aysegul Senturk, MD*,
  4. Aysegul Karalezli, MD*,
  5. Hatice Kilic, MD*,
  6. Gokhan Aykun, MD*,
  7. Derya Oztuna, PhD
  1. From the *Department of Chest Diseases, Ankara Ataturk Training and Research Hospital; and †Department of Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey.
  1. Received March 27, 2013, and in revised form November 2, 2013.
  2. Accepted for publication November 19, 2013.
  3. Reprints: Elif Babaoglu, MD, Ankara Ataturk Training and Research Hospital, Department of Chest Diseases, Bilkent, Ankara, Turkey. E-mail: elifbabaoglu{at}


Introduction Patients with pulmonary thromboembolism (PTE) are classified into 3 groups according to the clinical risk factors associated with mortality. High-risk patients and some of the intermediate-risk patients should be treated immediately to decrease the high mortality risk. Although clinical risk level of PTE can be determined by using echocardiography to evaluate right ventricle overload and pulmonary artery pressure findings, it may not be available in all emergency settings.

Aim The purpose of the study was to define the laboratory biomarkers, which can be used in place of echocardiography for PTE risk stratification.

Methods Patients (n = 98) were divided into 3 groups as high-risk (n = 13), intermediate-risk (n = 50), and low-risk (n = 35) groups, according to clinical risk factors at the first referral to hospital. Hepatic, cardiac, and renal markers were evaluated and compared among 3 groups.

Results Among biomarkers examined, lactate dehydrogenase, urea, creatinine, uric acid, troponin I, N-terminal–pro–B-type natriuretic peptide, creatine kinase–MB, D-dimer, and erythrocyte sedimentation rate (ESR) levels were found different between groups. All of these biomarkers except for ESR had positive correlation, whereas ESR had negative correlation with the mortality risk. An analysis of covariance for the age difference among patient groups showed that all the biomarkers other than urea and D-dimer levels remained significantly different among risk groups.

Conclusions At emergency conditions in which echocardiography assessment is not available, PTE patients who have increased levels of certain hepatic, cardiac, and renal biomarkers should cautiously be evaluated for having an increased risk for mortality. Increased levels of these biomarkers may guide the consideration for thrombolytic treatment.

Key Words
  • pulmonary thromboembolism
  • biomarkers
  • clinical risk assessment

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