N-Terminal Pro-Brain Natriuretic Peptide Levels in Patients Presenting with Acute Breathlessness in Emergency Department
Published: December 1, 2020 | DOI: https://doi.org/10.7860/JCDR/2020/46235.14360
Arun Bahulikar, Sunil Patel, Deepak Sadashiv Phalgune
1. Head Consultant Physician, Department of Medicine, Poona Hospital and Research Centre, Pune, Maharashtra, India.
2. Senior Resident, Department of Medicine, Poona Hospital and Research Centre, Pune, Maharashtra, India.
3. Research Consultant, Department of Research, Poona Hospital and Research Centre, Pune, Maharashtra, India.
Correspondence
Dr. Deepak Sadashiv Phalgune,
18/27, Bharat Kunj-1, Laxmi Bungalow, Erandawane, Pune-411038, Maharashtra, India.
E-mail: dphalgune@gmail.com
Introduction: Breathlessness is one of the most common symptoms in patients presenting to the emergency department. Differentiating Congestive Heart Failure (CHF) from other causes of dyspnea is of extreme importance. N-Terminal proBrain Natriuretic Peptide (NT-proBNP) levels may be valuable for the diagnosis of Heart Failure (HF) in patients with acute breathlessness when used in combination with other clinical information.
Aim: To find the utility of NT-proBNP levels in patients presenting with acute breathlessness.
Materials and Methods: This cross-sectional study was conducted on 255 patients presenting with acute breathlessness. Details of clinical history, clinical examination, laboratory tests, Electrocardiogram (ECG), X-ray chest, and 2D echocardiogram were collected from each patient. A 5 mL sample of peripheral venous blood was taken from the patients for the quantitative determination of NT-proBNP levels. Mann-Whitney U test was used to compare medians of continuous variables. Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy were determined for NT-proBNP levels.
Results: The mean age of the patients was 58.9 years. The median NT-proBNP level was significantly higher in patients who had HF compared to respiratory failure and Hyperventilation Syndrome (HVS). The sensitivity and specificity of NT-proBNP level >450 pg/mL was 76.9% and 90.0%, respectively for patients <50 years of age. The sensitivity and specificity of NTproBNP level >900 pg/mL was 82.9% and 92.3%, respectively for patients 50-75 years of age. The sensitivity and specificity of NT-proBNP level >1800 pg/mL was 61.5% and 100.0%, respectively for patients >75 years of age.
Conclusion: NT-proBNP measurement is a useful biochemical tool for the emergency room physician in the rapid and reliable diagnosis of HF in patients with acute breathlessness.
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