POINT-OF-CARE TESTING DURING MEDICAL EMERGENCY TEAM ACTIVATIONS: A PILOT STUDY.
Resuscitation. 2012 Feb 18;
Authors: Calzavacca P, Licari E, Tee A, Bellomo R
Abstract
OBJECTIVE: To estimate the prognostic value of point-of-care measurement of biomarkers related to dyspnea in patients receiving a Medical Emergency Team (MET) review. DESIGN: Prospective observational study. SETTING: University affiliated hospital. Patients: Cohort of 95 patients receiving MET review over a six month period METHODS: We used a commercial multi-biomarker panel for shortness-of-breath (SOB panel) (Biosite Triage Profiler, Biosite Incorporated, 9975 Summers Ridge Road San Diego, CA 92121, USA®) including Brain Natriuretic Peptide (BNP), D-dimer, myoglobin (Myo), creatine kinase MB isoenzyme, (CK-mB) and troponin I (Tn-I). We recorded information about demographics, MET review triggers, and MET procedures and patient outcome. RESULTS: Mean age was 70.5 (±15) years, 38 (41%) patients had a history of chronic heart failure (CHF) and 67 (70%) chronic kidney disease (CKD). At MET activation, 42 (44%) patients were dyspneic. The multi-biomarker panel was positive for at least one marker in 48 (51%) cases. BNP and D-dimer had a sensitivity of 0.79 and 0.93 for ICU admission with a negative predictive value (NPV) of 0.89 and 0.92 respectively. Thirty-five (37%) patients died. BNP was positive in 85% of such cases with sensitivity and NPV of 0.86 and 0.82, respectively. D-dimer was positive in 77% of non-survivors with a sensitivity and NPV of 0.94 and 0.88, respectively. BNP (area under the curve of receiver operating characteristic curve-AUC-ROC: 0.638) and D-dimer (AUC-ROC: 0.574) achieved poor discrimination of subsequent death. Similar findings applied to ICU admission. The combination of normal BNP and D-dimer levels completely ruled out ICU admission or death. The cardiac part of the panel was not useful in predicting ICU admission or mortality. CONCLUSIONS: Although, BNP and D-dimer are poor discriminants of ICU admission and hospital mortality, normal BNP and D-dimer levels practically exclude subsequent need for ICU admission and hospital mortality.
PMID: 22353639 [PubMed - as supplied by publisher]