Risk stratification in acute pulmonary embolism with heart-type fatty acid-binding protein: A meta-analysis

Objective: Heart-type fatty acid-binding protein (H-FABP) has emerged as a new biomarker in risk stratification of patients with acute pulmonary embolism(PE). We performed a meta-analysis of studies in patients with acute PE to assess the prognostic value of elevated H-FABP for short-term adverse outcomes. Data source: Two independent reviewers systematically searched PubMed, EMBASE, and Cochrane Database until June 2014. Data Selection: Studies were searched using MeSH word "fatty acid-binding protein" and "pulmonary embolism." Prospective studies were included if those were done on patients with acute PE and if serum H-FABP assay was done. Data Extraction: Relevant data on study design, year of publication, patient population, inclusion criteria, exclusion criteria, mean age, sex, type of H-FABP assay, cutoff of H-FABP used, and outcomes were extracted. The primary end point was 30-day complicated clinical course and PE-related mortality. The secondary end point was right ventricular dysfunction (RVD). A random-effects model was used to pool study results. Data Synthesis: Nine studies, including 1680 patients, reported data on the 30-day complicated clinical course. Elevated H-FABP was significantly associated with the increased risk of 30-day complicated clinical course (odds ratio [OR], 17.67; 95% confidence interval [CI], 6.02-51.89; I-2 = 80%). Similarly, 6 studies, including 676 patients, reported 30-day mortality data. Elevated H-FABP was associated with increased risk of 30-day PE-related mortality (OR, 32.94; 95% CI, 8.80-123.21, I-2 = 53%). The risk of RVD was significantly higher in patients with elevated H-FABP as compared with patients with normal H-FABP (OR, 2.57; 95% CI, 1.05-6.33, I-2 = 57%). The prognostic sensitivity and specificity of H-FABP were 71% and 74% in predicting 30-day complicated clinical course and were 90% and 70% in predicting 30-day mortality. Conclusion: This meta-analysis indicates that elevated H-FABP levels are associated with increased risk of 30-day complicated clinical course, mortality, and RVD. (C) 2015 Elsevier Inc. All rights reserved.