Analytical and clinical performance of three natriuretic peptide tests in the emergency room.
BACKGROUND
The aim of the present study was to investigate the analytical and diagnostic utility of B-type natriuretic peptide (BNP) and the N-terminus of this prohormone, N-terminal pro-BNP (NT-pro-BNP) testing in the emergency department to identify acute congestive heart failure (CHF).


METHODS
A blood sample taken from patients presenting to the emergency department with acute dyspnoea (n=80) was analyzed for natriuretic peptides using three different assays [Triage BNP (Biosite), Centaur BNP (Bayer) and Elecsys NT-pro-BNP (Roche)]. A cardiologist and a pulmonologist, blinded to the actual natriuretic peptide levels, reviewed all test results (including echocardiography, etc.) retrospectively and made a diagnosis of dyspnoea due to CHF or not.


RESULTS
Analytical testing showed good correlation and coefficients of variation of less than 10% for all three assays. Cardiac-related dyspnoea was found in 40 patients (50%). NT-proBNP and BNP values were significantly elevated in these patients. For identifying patients with CHF, BNP and NT-proBNP scored equally well (area under the receiver operating characteristic curve of 0.78, 0.77 and 0.78 for the Biosite, Roche and Bayer assays, respectively).


CONCLUSIONS
In general, the different assays tested for BNP and NT-pro-BNP correlate very well in patients with suspected CHF and may aid in the risk stratification process in emergency departments. However, the value must always be interpreted in conjunction with other clinical information. It should also be considered that renal impairment can affect the results.
Gorissen
Cecile
C
Department of Emergency Medicine, Atrium Medical Centre, Heerlen, The Netherlands.
Baumgarten
Ruben
R
de Groot
Monique
M
van Haren
Eric
E
Kragten
Hans
H
Leers
Mathie
M
D019540:Area Under Curve; D019411:Clinical Laboratory Techniques / Q000592:standards; D004417:Dyspnea / Q000175:diagnosis / Q000209:etiology; D004632:Emergency Medical Services / Q000379:methods*; D006333:Heart Failure / Q000175:diagnosis*; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000097:blood; D045265:Natriuretic Peptides / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood; D011933:Reagent Kits, Diagnostic / Q000592:standards
D045265:Natriuretic Peptides; D010446:Peptide Fragments; D011933:Reagent Kits, Diagnostic; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain