title: Diagnostic accuracy of BNP and NT-proBNP in patients presenting to acute care settings with dyspnea: a systematic review.
abstract: OBJECTIVE
  We sought to compare the diagnostic performance of B-type natriuretic peptide (BNP) and N-terminal proBNP measurements in patients presenting to acute care settings with dyspnea, a common presenting symptom of heart failure.
  
  
  METHODS
  We conducted a systematic review of the literature. For all included studies, we applied the QUADAS 14-question quality assessment tool for systematic reviews of diagnostic accuracy and abstracted the data for every published cut point.
  
  
  RESULTS
  We screened 4338 studies and included nine in the meta-analysis. All 9 studies scored positively on at least 50% of the QUADAS questions. The pooled estimates of sensitivity and specificity were the same for the BNP studies (0.97 (95% CI: 0.96, 0.98) and 0.70 (95% CI: 0.56, 0.85)) as for the NT-proBNP studies (0.95 (95% CI: 0.90, 1.01) and 0.72 (95% CI: 0.53, 0.90)). Tests for heterogeneity were significant in both subgroups: BNP (I(2)=97.9%, p<0.001) and NT-proBNP (I(2)=87.5%, p<0.001). Similar overall results were found for the likelihood and diagnostic odds ratios.
  
  
  CONCLUSIONS
  BNP and NT-proBNP have very similar diagnostic performance characteristics and can be used to rule out heart failure as a cause of dyspnea in the acute clinical setting. However, there is no easily identifiable optimum cut point value for each peptide.
authors.affiliation: Department of Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Worster
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Balion
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Hill
authors.forename: Pasqualina
authors.initials: P
authors.lastname: Santaguida
authors.forename: Afisi
authors.initials: A
authors.lastname: Ismaila
authors.forename: Robert
authors.initials: R
authors.lastname: McKelvie
authors.forename: Sonja M
authors.initials: SM
authors.lastname: Reichert
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McQueen
authors.forename: Lynda
authors.initials: L
authors.lastname: Booker
authors.forename: Parminder S
authors.initials: PS
authors.lastname: Raina
mesh_terms: D004417:Dyspnea / Q000150:complications*; D004632:Emergency Medical Services; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000032:analysis*; D010446:Peptide Fragments / Q000032:analysis*; D012680:Sensitivity and Specificity
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain