Predictive value of N-terminal Pro-brain Natriuretic Peptide combined with High-sensitivity Troponin-I for progression to high-risk status in acute pulmonary embolism

Background: Despite significant advances in the diagnosis and treatment of acute pulmonary embolism (APE), mortality remains high among high-risk APE patients. Timely identification of APE patients at risk of progression to high-risk status may enable intensified monitoring and timely treatment escalation, thereby potentially improving prognosis. The current guideline stratification system has a limited ability to distinguish patients likely to progress to high-risk status. This study aimed to evaluate the predictive value of combined NT-proBNP and hs-cTnI for clinical deterioration to high-risk states in APE patients. Methods: A retrospective study included patients with APE who were diagnosed by computed tomography pulmonary angiography (CTPA) from January 2022 to July 2024. Patients were classified according to the presence or absence of progression to high-risk status. Results: A total of 569 patients were enrolled, of whom 23 progressed to high-risk status and 546 did not. Both NT-proBNP and hs-cTnI were significant predictors of progression to high-risk status: NT-proBNP (OR: 1.019, 95%CI: 1.007-1.032, p = 0.002) and hs-cTnI (OR: 7.241, 95% CI: 2.916-17.983, p <0.001). The area under the ROC curve for the NT-proBNP and hs-cTnI combination in predicting progression to high-risk status was 0.852. Patients with elevated levels of both NT-proBNP (≥1860 pg/mL) and hs-cTnI (≥0.03 ng/mL) had a significantly higher rate of progression to high-risk status (25.9%), especially among intermediate-high risk patients (31.7%). Conclusions: The combination of NT-proBNP and hs-cTnI provides clinically useful prediction of impending deterioration to high-risk status in APE, particularly among intermediate-high risk patients.