Use of B-natriuretic peptide as a diagnostic marker in the differential diagnosis of transfusion-associated circulatory overload.
BACKGROUND
Transfusion-associated circulatory overload (TACO) occurs when the transfusion rate or volume exceeds the capacity of a compromised cardiovascular system. Characteristic symptoms and signs associated with TACO are neither sensitive nor specific. B-natriuretic peptide (BNP) is a 32-amino-acid polypeptide secreted from the cardiac ventricles in response to ventricular volume expansion and pressure overload. This study was performed to explore the usage of BNP in the differential diagnosis of TACO.


METHODS
Pre- and posttransfusion BNP levels were determined in 21 patients with suspected TACO and 19 control patients. The BNP was considered significant if the posttransfusion-to-pretransfusion ratio was at least 1.5 and the posttransfusion BNP level was at least 100 pg per mL.


RESULTS
The BNP test has a sensitivity and specificity of 81 and 89 percent, respectively, in diagnosis of TACO. It has a positive predictive value of 89 percent, a negative predictive value of 81 percent, and an accuracy of 87 percent. In logistic regression analysis, BNP was found to have significant predictive power independent of other clinical variables in models predicting which patients had TACO.


CONCLUSIONS
Our study suggests that in patients who present symptoms suggestive of TACO, BNP can be a useful adjunct marker in confirming volume overload as the cause of acute dyspnea and symptoms related to cardiovascular compromise.
Deparment of Pathology, The University of Michigan Medical School, University Hospital, Ann Arbor, Michigan 48109-0602, USA. lanzhou@umich.edu
Lan
L
Zhou
Donald
D
Giacherio
Laura
L
Cooling
Robertson D
RD
Davenport
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000175:diagnosis*; D016022:Case-Control Studies; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000209:etiology; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007118:Immunoassay; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood* / Q000737:chemistry; D011237:Predictive Value of Tests; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013610:Tachycardia / Q000209:etiology; D065227:Transfusion Reaction
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain