The significance of C-reactive protein for the prediction of net-adverse clinical outcome in patients with acute pulmonary embolism

Rade Milić; Boris Džudović; Bojana Subotić; Slobodan Obradović; Ivan Soldatović; Marina Petrović

doi:10.2298/VSP171213037M

Rade Milić Military Medical Academy, Clinic for Pulmonology, Belgrade, Serbia
Boris Džudović University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Bojana Subotić Military Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, Serbia
Slobodan Obradović University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Ivan Soldatović University of Belgrade, Institute for Biostatistics, Belgrade, Serbia
Marina Petrović University of Kragujevac, Faculty of Medical Sciences, Department of Internal Medicine, Kragujevac, Serbia

DOI: https://doi.org/10.2298/VSP171213037M

Keywords: c-reactive protein, mortality, prognosis, pulmonary embolism, treatment outcome

Abstract

Background/Aim. Acute pulmonary embolism (APE) may have different clinical manifestations. Also, its outcome can range from complete recovery to early death. Major bleeding (MB) as a due of the therapy also contributes to the overall adverse outcome. So far, it is unknown what the best predictors are for short-term mortality and MB among the several commonly used biomarkers. The aim of this study was to evaluate the significance of C-reactive protein (CRP) and other biomarkers for the prediction of adverse clinical outcomes. Methods. This clinical, observational, retrospective-prospective study included 219 consecutive adult patients treated for APE. Results. Among 219 patients, 22 (10%) died within the first month after diagnosis. Twenty seven patients (12.3%) had at least one episode of MB. Composite end-point [net-adverse clinical outcome (NACO)] was estimated in 47 (21.5%) of patients. The average values of all biomarkers were higher in the group of patient who died, and differences were statistically significant. Similar results were obtained for composite end-point. In terms of MB, none of biomarkers did not have significance, but CRP had a slight tendency toward significance. Results from univariate logistic regression model showed that troponin was statistically significant predictor of 30-day mortality. However, after adjusting for other variables, in multivariate logistic regression model troponin failed to be significant independent predictor of 30-day mortality. Unlike troponin, CRP and brain natriuretic peptide (BNP) were significant in all models – uni and multivariate (they were independent predictors of 30-day mortality). Conclusion. CRP has a good predictive value for 30-day mortality and NACO, and potential for MB in patients treated for APE.

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