CHEST Guidelines-The-Prognostic-Value-of-Plasma-Heart-Type-Fatty-Ac

The-Prognostic-Value-of-Plasma-Heart-Type-Fatty-Ac

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The correspondence by Dr. Anurag Bajaj discusses a meta-analysis conducted by Ruan et al., which evaluates the prognostic value of heart-type fatty acid-binding protein (H-FABP) in patients with acute pulmonary embolism (PE). The study is important as acute PE is a serious and potentially fatal condition. The meta-analysis reviewed five prospective studies to compare 30-day mortality and 30-day complicated clinical events (CCEs) in acute PE patients with elevated H-FABP levels to those with normal levels.<br /><br />Dr. Bajaj points out that while this meta-analysis is insightful, overlap in patient populations between two of the included studies may skew the results. Removing the overlap and focusing on the study with the larger patient volume alters the odds ratios (ORs) for the outcomes. For 30-day mortality, the OR changes to 31.38, and for CCEs, it is 25.93. The adjustments also affect the sensitivity and specificity of the predictions for mortality and serious events, initially reported at 98% and 77% for mortality, and 86% and 82% for CCEs, respectively.<br /><br />The correspondence underscores the role of H-FABP in risk stratification for PE patients, particularly those who are hemodynamically stable but have right ventricular dysfunction (RVD). Currently, there are no standardized guidelines for managing these stable yet high-risk patients. Dr. Bajaj suggests that H-FABP could aid in the development of management strategies for such patients.<br /><br />In summary, the correspondence emphasizes the significance of H-FABP as a prognostic marker for PE, while noting methodological considerations that may affect the findings of the meta-analysis. This reinforces the need for precision in evaluating and addressing the risks in PE patient management.

Keywords

H-FABP

acute pulmonary embolism

prognostic value

meta-analysis

30-day mortality

complicated clinical events

risk stratification

right ventricular dysfunction

patient management

methodological considerations