NT-proBNP in the differential diagnosis of acute dyspnea in the emergency department.
OBJECTIVE
The purpose of this study was to verify the usefulness of NT-proBNP in the differential diagnosis of dyspnea in a population of patients presenting in the ER with breathlessness.


METHODS
In samples from 122 patients presenting in the ER with acute-severe dyspnea and from 25 subjects enrolled as a "comparison group" (NORM), NT-proBNP levels were measured. Patients have been classified on the basis of discharge diagnosis: pulmonary disease (PD, n = 23), pulmonary concomitant to cardiac disease (MIXED, n = 17), pulmonary embolism (EMB, n = 8), cardiac disease (CARD, n = 56), acute myocardial infarction (AMI, n = 11) and other disease (OTHER, n = 7).


RESULTS
A significant difference in NT-proBNP values (P <or= 0.05) was found in CARD vs. PD as well as vs. NORM and OTHER groups. 1760 ng/L was the best cut-off value calculated from ROC analysis (AUC +/- SE 0.815 +/- 0.041). Comparing NT-proBNP values and ER diagnosis, a disagreement in 24 patients was observed. Using the discharge diagnosis as the "gold standard," four cases (17%) were found to be FP and 11 cases (46%) were FN according to ER diagnosis, while 2 patients showed false positive and 7 false negative NT-proBNP values.


CONCLUSIONS
NT-proBNP measurement represents a useful biochemical tool helping the ER physician in the rapid and reliable recognition of cardiac involvement in patients presenting in the ER with acute-severe dyspnea.
Zaninotto
Martina
M
Department of Laboratory Medicine, University-Hospital, Padova, Italy.
Mion
Monica
M
Altinier
Sara
S
Pastorello
Mara
M
Rocco
Stefano
S
Tosato
Franco
F
Iliceto
Sabino
S
Plebani
Mario
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000175:diagnosis; D006333:Heart Failure / Q000175:diagnosis; D006801:Humans; D008171:Lung Diseases / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011655:Pulmonary Embolism / Q000175:diagnosis
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain