Usefulness of B-type natriuretic peptide in elderly patients with acute dyspnea
- 199 Downloads
Differentiating cardiogenic pulmonary edema (CPE) from respiratory causes of dyspnea is particularly difficult in elderly patients. The aim of our study was to evaluate B-type natriuretic peptide (BNP) in patients older than 65 years presenting with acute dyspnea.
Medical emergency department of a 2000-bed urban teaching hospital.
Patients aged over 65 years presenting with acute dyspnea and a respiratory rate more than 25/min or a PaO2 below 70 mmHg, SpO2 less than 92%, PaCO2 higher than 45 mmHg with pH less than 7.35, were included. BNP levels, measured blind at admission were compared with the final diagnosis (CPE or no CPE) as defined by experts.
Measurements and results
Three hundred eight patients (mean age of 80 years) were enrolled in the study. The median BNP was 575 pg/ml [95% confidence interval (CI): 410–898] in the CPE group (n=141) versus 75 pg/ml (95% CI: 59–98) in the no CPE group (n=167) (p<0.001). The best threshold value of BNP was 250 pg/ml, with a sensitivity and specificity for CPE of 0.78 (95% CI: 0.71–0.84) and 0.90 (95% CI: 0.84–0.93), respectively. The area under the ROC curve was 0.874±0.081 (p<0.001). The accuracy of BNP-assisted diagnosis was higher than that of the emergency physician (0.84 versus 0.77, p<0.05).
Analysis of BNP is useful in elderly patients with acute dyspnea, but the threshold value is higher than that previously determined.
KeywordsAcute dyspnea Elderly patients Emergency department Cardiogenic pulmonary edema B-type natriuretic peptide
The authors would like to thank the physicians and nursing staff working in the emergency department and all the physicians of the EPIDASA study group: Dr M.-H. Becquemin, Dr J. Boddaert, Dr R. Isnard and Dr A. Teixeira, for their cooperation and support. We also thank Dr D.J. Baker (Department of Anesthesiology, CHU Necker-Enfants Malades, Paris, France) for reviewing the manuscript.
This study was supported solely from departmental sources. The test and kits for BNP assay were provided free of charge by Biosite USA/BMD France.
- 13.Maisel AS, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P, Omland T, Storrow AB, Abraham W, Wu A, Clopton P, Steg G, Westheim A, Wold Knudsen C, Perez A, Kazanegra R, Herrmann H, McCullough P (2002) Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 347:161–167CrossRefPubMedGoogle Scholar
- 15.Ho KK, Pinsky JL, Kannel WB, Levy D (1993) The epidemiology of heart failure: the Framingham Study. J Am Coll Cardiol 2:6A-13AGoogle Scholar
- 16.Ray P, Birolleau S, Lefort Y, Beigelman C, Becquemin M-H, Isnard R, Boddaert J, Teixeira A, Riou B (2002) Epidemiological study of acute dyspnea in elderly patients, in an emergency department. The EPIDASA study. Am J Respir Crit Care Med 165:A265Google Scholar
- 23.Maisel AS, Koon J, Krishnaswamy P, Kazenegra R, Clopton P, Gardetto N, Morrisey R, Garcia A, Chiu A, De Maria A (2001) Utility of B-natriuretic peptide as a rapid, point-of-care test for screening patients undergoing echocardiography to determine left ventricular dysfunction. Am J Heart 141:367–374CrossRefGoogle Scholar
- 26.McCullough PA, Duc P, Omland T, McCord J, Nowak RM, Hollander JE, Herrmann HC, Steg PG, Westheim A, Knudsen CW, Storrow AB, Abraham WT, Lamba S, Wu AH, Perez A, Clopton P, Krishnaswamy P, Kazanegra R, Maisel AS, Breathing Not Properly Multinational Study Investigators (2003) B-type natriuretic peptide and renal function in the diagnosis of heart failure: an analysis from the Breathing Not Properly Multinational Study. Am J Kidney Dis 41:571–579CrossRefPubMedGoogle Scholar
- 33.McCullough PA, Nowak RM, McCord J, Hollander JE, Herrmann HC, Steg PG, Duc P, Westheim A, Omland T, Knudsen CW, Storrow AB, Abraham WT, Lamba S, Wu AH, Perez A, Clopton P, Krishnaswamy P, Kazanegra R, Maisel AS (2002) B-type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: analysis from Breathing Not Properly (BNP) Multinational Study. Circulation 106:416–422CrossRefPubMedGoogle Scholar