Performance of N-terminal-pro-B-type natriuretic peptide in critically ill patients: a prospective observational cohort study.
Crit Care. 2008 Nov 6;12(6):R137
Authors: Coquet I, Darmon M, Doise JM, Degres M, Blettery B, Schlemmer B, Gambert P, Quenot JP
ABSTRACT: INTRODUCTION: To assess the accuracy of N-terminal-pro-B-type natriuretic peptide (NT-proBNP) as a diagnostic tool to recognize acute respiratory failure of cardiac origin in an unselected cohort of critically ill patients. METHODS: Prospective observational study of medical intensive care unit (ICU) patients. NT-proBNP was measured at ICU admission, and diagnosis of cardiac dysfunction relied on the patient's clinical presentation and echocardiography. RESULTS: Of the 198 patients included in this study, 102 (51.5%) had evidence of cardiac dysfunction. Median NT-proBNP concentrations were 5720 ng/L [1430-15698] and 854 ng/L [190-3560] in patients with and without cardiac dysfunction, respectively (p < 0.0001). In addition, NT-proBNP concentrations were correlated with age (rho= 0.43; p < 0.0001) and inversely correlated with creatinine clearance (rho= -0.58; p < 0.0001). When evaluating the performance of NT-proBNP concentrations to detect cardiac dysfunction, the area under the ROC curve was 0.76 (95% CI 0.69-0.83). In addition, a stepwise logistic regression model revealed that NT-proBNP (OR = 1.01 per 100 ng/L; 95% CI 1.002-1.02), ECG modifications (OR = 11.03; 95% CI 5.19-23.41), and severity assessed by OSF score (OR = 1.63 per point; 95% CI 1.17-2.41) adequately predicted cardiac dysfunction. The area under the ROC curve of this model was of 0.83 (95% CI 0.77-0.90). CONCLUSIONS: NT-proBNP measured at ICU admission might represent a useful marker to exclude cardiac dysfunction in critically ill patients.
PMID: 18990203 [PubMed - as supplied by publisher]