Performance of N-terminal-pro-B-type natriuretic peptide in critically ill patients: a prospective observational cohort study.
BACKGROUND
The purpose of this study was to assess the accuracy of N-terminal-pro-B-type natriuretic peptide (NT-proBNP) as a diagnostic tool to recognize acute respiratory failure of cardiac origin in an unselected cohort of critically ill patients.


METHODS
We conducted a prospective observational study of medical ICU patients. NT-proBNP was measured at ICU admission, and diagnosis of cardiac dysfunction relied on the patient's clinical presentation and echocardiography.


RESULTS
Of the 198 patients included in this study, 102 (51.5%) had evidence of cardiac dysfunction. Median NT-proBNP concentrations were 5,720 ng/L (1,430 to 15,698) and 854 ng/L (190 to 3,560) in patients with and without cardiac dysfunction, respectively (P < 0.0001). In addition, NT-proBNP concentrations were correlated with age (rho = 0.43, P < 0.0001) and inversely correlated with creatinine clearance (rho = -0.58, P < 0.0001). When evaluating the performance of NT-proBNP concentrations to detect cardiac dysfunction, the area under the receiver operating characteristic (ROC) curve was 0.76 (95% confidence interval (CI) 0.69 to 0.83). In addition, a stepwise logistic regression model revealed that NT-proBNP (odds ratio (OR) = 1.01 per 100 ng/L, 95% CI 1.002 to 1.02), electrocardiogram modifications (OR = 11.03, 95% CI 5.19 to 23.41), and severity assessed by organ system failure score (OR = 1.63 per point, 95% CI 1.17 to 2.41) adequately predicted cardiac dysfunction. The area under the ROC curve of this model was 0.83 (95% CI 0.77 to 0.90).


CONCLUSIONS
NT-proBNP measured at ICU admission might represent a useful marker to exclude cardiac dysfunction in critically ill patients.
Coquet
Isaline
I
Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, 1 Avenue Claude Vellefaux, Paris, 75010, France. icoquet@aol.com
Darmon
Michael
M
Doise
Jean-Marc
JM
Degrès
Michel
M
Blettery
Bernard
B
Schlemmer
Benoît
B
Gambert
Philippe
P
Quenot
Jean-Pierre
JP
D000368:Aged; D015415:Biomarkers; D002303:Cardiac Output, Low / Q000175:diagnosis / Q000503:physiopathology; D015331:Cohort Studies; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012131:Respiratory Insufficiency / Q000097:blood* / Q000175:diagnosis / Q000209:etiology
D015415:Biomarkers; D011498:Protein Precursors; D020097:Natriuretic Peptide, Brain