title: Diagnostic utility of C-reactive protein combined with brain natriuretic peptide in acute pulmonary edema: a cross sectional study.
abstract: BACKGROUND
  Discriminating acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) from cardiogenic pulmonary edema (CPE) using the plasma level of brain natriuretic peptide (BNP) alone remains controversial. The aim of this study was to determine the diagnostic utility of combination measurements of BNP and C-reactive protein (CRP) in critically ill patients with pulmonary edema.
  
  
  METHODS
  This was a cross-sectional study. BNP and CRP data from 147 patients who presented to the emergency department due to acute respiratory failure with bilateral pulmonary infiltrates were analyzed.
  
  
  RESULTS
  There were 53 patients with ALI/ARDS, 71 with CPE, and 23 with mixed edema. Median BNP and CRP levels were 202 (interquartile range 95-439) pg/mL and 119 (62-165) mg/L in ALI/ARDS, and 691 (416-1,194) pg/mL (p < 0.001) and 8 (2-42) mg/L (p < 0.001) in CPE. BNP or CRP alone offered good discriminatory performance (C-statistics 0.831 and 0.887), but the combination offered greater one [C-statistics 0.931 (p < 0.001 versus BNP) (p = 0.030 versus CRP)]. In multiple logistic-regression, BNP and CRP were independent predictors for the diagnosis after adjusting for other variables.
  
  
  CONCLUSIONS
  Measurement of CRP is useful as well as that of BNP for distinguishing ALI/ARDS from CPE. Furthermore, a combination of BNP and CRP can provide higher accuracy for the diagnosis.
authors.affiliation: Department of Internal Medicine, Oita University Faculty of Medicine, Yufu, Japan.
authors.forename: Kosaku
authors.initials: K
authors.lastname: Komiya
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ishii
authors.forename: Shinji
authors.initials: S
authors.lastname: Teramoto
authors.forename: Osamu
authors.initials: O
authors.lastname: Takahashi
authors.forename: Nobuoki
authors.initials: N
authors.lastname: Eshima
authors.forename: Ou
authors.initials: O
authors.lastname: Yamaguchi
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Ebi
authors.forename: Junji
authors.initials: J
authors.lastname: Murakami
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Jun-ichi
authors.initials: J
authors.lastname: Kadota
mesh_terms: D000208:Acute Disease; D055371:Acute Lung Injury / Q000150:complications / Q000175:diagnosis; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D016009:Chi-Square Distribution; D016638:Critical Illness; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011237:Predictive Value of Tests; D011654:Pulmonary Edema / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D012372:ROC Curve; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000175:diagnosis; D012131:Respiratory Insufficiency / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein