Plasma Angiopoietin-2 as a Promising Biomarker for the Prognosis of Acute Pulmonary Embolism

Background: Endothelial damage is one of the pathogenic conditions of acute pulmonary embolism (APE). The es-sential role of angiogenin, ribonuclease A family, member 2 (Ang-2) in APE remains unclear. This study aimed to investigate the predictive value of Ang-2 in the clinical outcomes of patients with APE. Methods: Plasma Ang-2 levels were measured by an enzyme-linked immunosorbent assay kit using a DuoSet methodology in 118 APE patients and 53 healthy controls. Baseline data relevant to mortality over time were ob-tained from hospital databases or by patient's follow-up (median follow-up time: 25.0 +/- 13.2 months). The main outcome was all-cause mortality. Results: Plasma Ang-2 level was significantly higher in APE patients than in healthy controls (p < 0.001). Patients dying during the first 30 days presented higher baseline levels of Ang-2 than the survivors (p < 0.001). Patients dying during the follow-up also showed higher baseline levels of Ang-2 than the survivors (p < 0.001). The multi-variable logistic regression analysis showed that the N-terminal propeptide of B-type natriuretic peptide (NT-proBNP) [odds ratio (OR): 19.8; 95% CI: 1.5 -255.8; p = 0.022] and Ang-2 (OR: 9.9; 95% CI: 1.4 -70.5; p = 0.022) emerged as independent predictors of the 30-day mortality. Furthermore, the multivariable Cox's regres-sion identified plasma Ang-2 [hazards ratio (HR): 1.35; 95% CI: 1.10 -1.66; p = 0.004] as an independent pre-dictor of long-term mortality in patients with APE. Conclusions: A high circulating level of Ang-2 can be considered as an independent predictor for the poor out-come of APE and may serve as a biomarker for the risk stratification in patients with APE. (Clin. Lab. 2022;68:xx-xx. DOI: 10.7754/Clin.Lab.2021.210709)