Role of N-terminal pro-B-type natriuretic peptide in risk stratification in patients presenting in the emergency room. Export

@article{citeulike:1218066, abstract = {BACKGROUND: Natriuretic peptides are promising markers in diagnosing acute and chronic heart failure and assessing prognosis in these patients. Increasing routine use to unselected patients is challenged by false-positive results. The aims of this study were to assess (a) the distributions of N-terminal B-type natriuretic peptide (NT-proBNP) values in various diagnostic groups, (b) factors that influence NT-proBNP, and (c) the value of NT-proBNP in risk stratification in unselected emergency room (ER) patients. METHODS: NT-proBNP was measured in 876 unselected consecutive patients [mean (SD) age, 58 (18) years; 53\% male] attending the ERs of 2 university hospitals and 1 community hospital. Diagnoses, age, sex, hemoglobin, creatinine (CREA), C-reactive protein (CRP), troponin T, and intensity of care were documented. In a subset consisting of all 417 patients at 1 center, in-hospital follow-up was completed with respect to a complicated clinical course, including intensive care treatment and death. RESULTS: NT-proBNP was significantly increased in patients with cardiac diagnoses or histories compared with patients with only pulmonary or other diagnoses. In patients with other diagnoses, NT-proBNP values increased significantly with the number of atherosclerotic risk factors (P=0.044). Age, renal function, CRP, and to a much lesser extent, hemoglobin significantly influenced NT-proBNP values. The amount of care was positively correlated with NT-proBNP (P<0.001). Classification and regression tree analysis showed a superior impact of NT-proBNP for identification of high-risk patients. CONCLUSIONS: NT-proBNP is a promising marker for identification of patients with structural heart disease in the ER and a suitable tool for risk stratification. Its use in the ER should be limited to clearly clinically defined patient groups at present to avoid a potential excess of additional diagnostic procedures in positive but asymptomatic patients.}, address = {Department of Cardiology and Institute for Clinical Chemistry, Charit\'{e}-University Medicine Berlin, Campus Virchow-Klinikum, Berlin, Germany. martin.moeckel@charite.de}, author = {M\"{o}ckel, M. and M\"{u}ller, R. and Vollert, J. O. and M\"{u}ller, C. and Carl, A. and Peetz, D. and Post, F. and Kohse, J. K. and Lackner, K. J.}, citeulike-article-id = {1218066}, citeulike-linkout-0 = {http://dx.doi.org/10.1373/clinchem.2005.049155}, citeulike-linkout-1 = {http://view.ncbi.nlm.nih.gov/pubmed/16120947}, citeulike-linkout-2 = {http://www.hubmed.org/display.cgi?uids=16120947}, doi = {10.1373/clinchem.2005.049155}, issn = {0009-9147}, journal = {Clin Chem}, keywords = {bnp, chf}, month = {September}, number = {9}, pages = {1624--1631}, posted-at = {2007-04-09 18:15:36}, priority = {2}, title = {Role of N-terminal pro-B-type natriuretic peptide in risk stratification in patients presenting in the emergency room.}, url = {http://dx.doi.org/10.1373/clinchem.2005.049155}, volume = {51}, year = {2005} }

TY - JOUR ID - citeulike:1218066 L3 - citeulike-article-id:1218066 N2 - BACKGROUND: Natriuretic peptides are promising markers in diagnosing acute and chronic heart failure and assessing prognosis in these patients. Increasing routine use to unselected patients is challenged by false-positive results. The aims of this study were to assess (a) the distributions of N-terminal B-type natriuretic peptide (NT-proBNP) values in various diagnostic groups, (b) factors that influence NT-proBNP, and (c) the value of NT-proBNP in risk stratification in unselected emergency room (ER) patients. METHODS: NT-proBNP was measured in 876 unselected consecutive patients [mean (SD) age, 58 (18) years; 53% male] attending the ERs of 2 university hospitals and 1 community hospital. Diagnoses, age, sex, hemoglobin, creatinine (CREA), C-reactive protein (CRP), troponin T, and intensity of care were documented. In a subset consisting of all 417 patients at 1 center, in-hospital follow-up was completed with respect to a complicated clinical course, including intensive care treatment and death. RESULTS: NT-proBNP was significantly increased in patients with cardiac diagnoses or histories compared with patients with only pulmonary or other diagnoses. In patients with other diagnoses, NT-proBNP values increased significantly with the number of atherosclerotic risk factors (P=0.044). Age, renal function, CRP, and to a much lesser extent, hemoglobin significantly influenced NT-proBNP values. The amount of care was positively correlated with NT-proBNP (P<0.001). Classification and regression tree analysis showed a superior impact of NT-proBNP for identification of high-risk patients. CONCLUSIONS: NT-proBNP is a promising marker for identification of patients with structural heart disease in the ER and a suitable tool for risk stratification. Its use in the ER should be limited to clearly clinically defined patient groups at present to avoid a potential excess of additional diagnostic procedures in positive but asymptomatic patients. IS - 9 JF - Clin Chem SN - 0009-9147 AD - Department of Cardiology and Institute for Clinical Chemistry, Charité-University Medicine Berlin, Campus Virchow-Klinikum, Berlin, Germany. martin.moeckel@charite.de EP - 1631 TI - Role of N-terminal pro-B-type natriuretic peptide in risk stratification in patients presenting in the emergency room. VL - 51 SP - 1624 KW - bnp KW - chf AU - Möckel, M AU - Müller, R AU - Vollert, JO AU - Müller, C AU - Carl, A AU - Peetz, D AU - Post, F AU - Kohse, JK AU - Lackner, KJ PY - 2005/09// UR - http://dx.doi.org/10.1373/clinchem.2005.049155 ER -