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Validity of Amino Terminal pro-Brain Natiuretic Peptide in a Medically Complex Elderly Population.
MedLine Citation:
PMID:  22121398     Owner:  NLM     Status:  PubMed-not-MEDLINE    
BACKGROUND: The routine use of natiuretic peptides in severely dyspneic patients has recently been called into question. We hypothesized that the diagnostic utility of Amino Terminal pro Brain Natiuretic Peptide (NT-proBNP) is diminished in a complex elderly population.
METHODS: We studied 502 consecutive patients in whom NT-proBNP values were obtained to evaluate severe dyspnea in the emergency department. The diagnostic utility of NT-proBNP for the diagnosis of congestive heart failure (CHF) was assessed utilizing several published guidelines, as well as the manufacturers suggested age dependent cut-off points.
RESULTS: The area under the receiver operator curve (AUC) for NT-proBNP was 0.70. Using age-related cut points, the diagnostic accuracy of NT-proBNP for the diagnosis of CHF was below prior reports (70% vs. 83%). Age and estimated creatinine clearance correlated directly with NT-proBNP levels, while hematocrit correlated inversely. Both age > 50 years and to a lesser extent hematocrit < 30% affected the diagnostic accuracy of NT-proBNP, while renal function had no effect. In multivariate analysis, a prior history of CHF was the best predictor of current CHF, odds ratio (OR) = 45; CI: 23-88.
CONCLUSIONS: The diagnostic accuracy of NT-proBNP for the evaluation of CHF appears less robust in an elderly population with a high prevalence of prior CHF. Age and hematocrit levels, may adversely affect the diagnostic accuracy off NT-proBNP.
KEYWORDS: Congestive Heart Failure; Natriuretic peptides; Diagnosis; Elderly Patients.
Mazhar A Afaq; Azadeh Shoraki; Oleg Ivanov; Janardhan Srinivasan; Lawrence Bernstein; Stuart W Zarich
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of clinical medicine research     Volume:  3     ISSN:  1918-3011     ISO Abbreviation:  J Clin Med Res     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-11-28     Completed Date:  2012-08-23     Revised Date:  2012-09-10    
Medline Journal Info:
Nlm Unique ID:  101538301     Medline TA:  J Clin Med Res     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  156-63     Citation Subset:  -    
Departments of Medicine (Division of Cardiovascular Medicine) and Pathology, Bridgeport Hospital, Bridgeport, CT., Yale University School of Medicine, USA.
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