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DOI: 10.1160/TH13-08-0663
A novel H-FABP assay and a fast prognostic score for risk assessment of normotensive pulmonary embolism
Financial support: The study was supported by a grant from the University of Göttingen (Heidenreich von Siebold Programme) to C.D. and a scholarship by the Südwestdeutsche Gesell-schaft für Innere Medizin to C.D. and M.L.. Furthermore, the study was supported by the Federal Ministry of Education and Research (BMBF 01EO1003). The authors are responsible for the contents of this publication.
Publication History
Received:
12 August 2013
Accepted after major revision:
19 January 2013
Publication Date:
01 December 2017 (online)
Summary
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.
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