title: Role of N-terminal pro-B-type natriuretic peptide in risk stratification in patients presenting in the emergency room.
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.
authors.affiliation: Department of Cardiology and Institute for Clinical Chemistry, Charité-University Medicine Berlin, Campus Virchow-Klinikum, Berlin, Germany. martin.moeckel@charite.de
authors.forename: Martin
authors.initials: M
authors.lastname: Möckel
authors.forename: Reinhold
authors.initials: R
authors.lastname: Müller
authors.forename: Jörn O
authors.initials: JO
authors.lastname: Vollert
authors.forename: Christian
authors.initials: C
authors.lastname: Müller
authors.forename: Angelika
authors.initials: A
authors.lastname: Carl
authors.forename: Dirk
authors.initials: D
authors.lastname: Peetz
authors.forename: Felix
authors.initials: F
authors.lastname: Post
authors.forename: J Klaus
authors.initials: JK
authors.lastname: Kohse
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Lackner
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D004632:Emergency Medical Services; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000175:diagnosis*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D018570:Risk Assessment; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein; D003404:Creatinine