EVALUATION OF SERIAL BIOMARKERS IN INTERMEDIATE-RISK PATIENTS WITH ACUTE PULMONARY EMBOLISM

ABSTRACT

SESSION TITLE All About the CLOT VTE SESSION TYPE Original Investigations PRESENTED ON 10/16/2022 1030 am - 1130 am PURPOSE: Patients diagnosed with intermediate high-risk pulmonary embolism (IHRPE) may develop early clinical decompensation requiring advanced reperfusion therapy. The clinical parameters and biomarkers which may prognosticate this progression to high risk acute PE are not clearly defined in the current clinical practice guidelines. There remains a critical knowledge gap regarding identifying the 5-17% of patients who will demonstrate decompensation within the first 72 hours after initial presentation. We measured serial acute PE biomarkers to better understand their patterns of evolution. METHODS: Single arm prospective observational pilot study measuring serial biomarkers in newly diagnosed and hospitalized IHRPE patients (age >18 years) meeting ESC 2019 criteria. Vital signs (HR, SBP, SI, SPO2/FiO2 index) were recorded at seven pre-specified times to assess clinical course during the first 72 hours. Blood biomarkers were evaluated during the same pre-specified time blocks. Cardiac biomarkers (NT Pro BNP, troponin) were measured every 8 hours for first 24 hours and then every 12 hours. Non-cardiac biomarkers (uric acid, lactate) were measured once every 24 hours. RESULTS: Total of 20 subjects (16M) were diagnosed via CT angiogram and enrolled after informed consent. Median age was 61.5 years (IQR 53, 72.5). Comorbidities included underlying malignancy (5), prior history of VTE (3) and Covid-19 (1). Radiographic embolus patterns included saddle (9), distal main PA/lobar (9) and segmental/sub-segmental (2). Lower extremity DVT were found in 14 subjects. Median admission vital signs (IQR) at time of presentation were Heart rate 110 BPM (101,118), SBP 116 mmHg (100, 132);RR 21 per min (16, 23);Shock index 0.9 (0.8, 1.1);SPO2 85% (85, 96);and SPO2/FiO2 ratio 289 (246, 454). Subjects were admitted to the medical ward (13) and ICU (7). 16 remained clinically stable and 4 had clinical decompensation (2 respiratory failure, 2 shock) of whom 2 expired. At enrollment, troponin (TNT) was elevated in 20/20 subjects, NT proBNP in 18/20subjects, lactate in 8/20 subjects, and uric acid in 9/20 subjects;biomarkers normalized at different rates, with marked inter-individual variation. The median (IQR) peak values were TNT, 0.05 (0.025, 0.078) ng/ml;NTproBNP, 2458 (1147, 5599) pg/ml;lactate, 1.8 (1.4, 3.4) mmol/L;and, uric acid, 6.2 (5.0, 7.4) mg/dl. 1/16 (6.3%) stable patients showed an 8-16 hr increase in TNT, compared with 2/4 (50%) of the decompensated patients, who required subsequent advanced PE interventions (p=0.088). CONCLUSIONS: Biomarkers in IHRPE patients evolve with variable time-courses. The potential of rising troponin at 16 hours to identify risk for circulatory or respiratory decompensation deserves further investigation. CLINICAL IMPLICATIONS Abnormal biomarkers may aid clinical decision-making regarding advanced therapies in IHRPE patients. DISCLOSURES No relevant relationships by Wendy Craig No relevant relationships by Ariel McKenna No relevant relationships by Victoria Molina No relevant relationships by Alexander Smith No relevant relationships by Hilamber Subba Advisory Committee Member relationship with ACI Clinical Please note 2020-2022 Added 04/04/2022 by Joel Wirth, value=Salary