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Review
. 2025 May 20;17(5):e84460.
doi: 10.7759/cureus.84460. eCollection 2025 May.

The Role of N-terminal Pro-B-Type Natriuretic Peptide, Troponins, and D-dimer in Acute Cardio-Respiratory Syndromes: A Multi-specialty Systematic Review

Muhammad Ibrahim  1 , Jawad Ahmad  2 , Muhammad Abbas  3 , Zainullah  4 , Zeeshan Umar  5 , Momal Nasir  6 , Kabsha Zain  7 , Jamil Ahmad  8 , Seemab Arshad  9 , Atif Bashir  8 , Sami Ullah  8 , Zubair Ahmad  10 , Sundas Safdar  11
Affiliations
Review

The Role of N-terminal Pro-B-Type Natriuretic Peptide, Troponins, and D-dimer in Acute Cardio-Respiratory Syndromes: A Multi-specialty Systematic Review

Muhammad Ibrahim et al. Cureus. .

Abstract

This systematic review evaluates the diagnostic and prognostic utility of N-terminal pro-B-type natriuretic peptide (NT-proBNP), cardiac troponins, and D-dimer in acute cardio-respiratory syndromes, including heart failure (HF), acute coronary syndrome (ACS), pulmonary embolism (PE), acute respiratory distress syndrome (ARDS), and coronavirus disease 2019 (COVID-19)-related complications. These biomarkers play critical roles in assessing myocardial stress, injury, and thrombosis risk, offering a rapid and cost-effective alternative to traditional diagnostic tools. A comprehensive literature search from 2015 to 2024 identified 14 high-quality studies, demonstrating NT-proBNP's strong correlation with HF severity and mortality risk in severe COVID-19, while cardiac troponins were associated with myocardial injury in ARDS and ACS. D-dimer emerged as a predictor of thrombotic complications and poor outcomes in interstitial lung disease (ILD) and PE. The combined use of these biomarkers significantly improved risk stratification, enabling early intervention and reducing unnecessary imaging and invasive testing. A multi-marker approach provided superior predictive accuracy for mortality and recurrence risk in PE compared to single biomarker assessments. Despite some methodological limitations, including heterogeneity in biomarker thresholds, the findings support the integration of these markers into routine clinical practice to enhance early diagnosis and patient management. Future research should focus on standardizing biomarker cut-off values, conducting large-scale multi-center trials, and incorporating biomarker data into artificial intelligence (AI)-driven decision systems. This study highlights the potential of biomarker-driven risk assessment in cardio-respiratory medicine, paving the way for more precise, early, and effective intervention strategies to optimize patient outcomes and advance precision medicine in critical care settings.

Keywords: biomarkers; cardio-respiratory syndromes; d-dimer; nt-probnp; troponins.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. PRISMA Flow Chart
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses
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