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Comparison of brain natriuretic peptide and probrain natriuretic peptide in the diagnosis of cardiogenic pulmonary edema in patients aged 65 and older.
J Am Geriatr Soc. 2005 Apr; 53(4):643-8.JA

Abstract

OBJECTIVES

Differentiating cardiogenic pulmonary edema (CPE) from respiratory causes of dyspnea is difficult in elderly patients. The aim of this study was to compare the usefulness of B-type natriuretic peptide (BNP) and amino-terminal fragment BNP (proBNP), to diagnose CPE in patients aged 65 and older.

DESIGN

Prospective study.

SETTING

Medical emergency department of a 2,000-bed urban teaching hospital.

PARTICIPANTS

Patients aged 65 and older presenting with acute dyspnea and a respiratory rate of 25 breaths/min or greater, a partial pressure of oxygen of 70 mmHg or less, or an oxygen saturation of 92% or less were included.

MEASUREMENTS

Rapid BNP and proBNP assays, performed blind at admission, were compared with the final diagnosis (CPE or no CPE) as defined by an expert team.

RESULTS

Two hundred two patients (mean age+/-standard deviation 80+/-9) were included; 88 (44%) had CPE. There was a strong correlation between proBNP and BNP values (correlation coefficient=0.91, P<.001). The median BNP and proBNP were higher in the group of patients with CPE (377 vs 74 pg/mL, P<.001, and 3,851 vs 495 pg/mL, P<.001, respectively). The best threshold values of BNP and proBNP were 250 pg/mL and 1,500 pg/mL, respectively. The area under the receiver operating characteristic curve was greater with BNP than with proBNP (0.85 vs 0.80, P<.05). BNP assay was more accurate in diagnosis than the emergency physician, whereas proBNP was not. Higher values of BNP and proBNP were associated with greater in-hospital mortality.

CONCLUSION

BNP assay is a more useful diagnostic indicator for CPE than proBNP in patients aged 65 and older.

Authors+Show Affiliations

Department of Emergency Medicine and Surgery, Center Hospitalo-Universitaire, Pitié-Salpêtrière, Assistance-Publique Hôpitaux de Paris, Université Pierre et Marie Curie, 47-83 boulevard de l'hôpital, 75013 Paris, France. patrick.ray@psl.ap-hop-paris.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Evaluation Study
Journal Article

Language

eng

PubMed ID

15817011

Citation

Ray, Patrick, et al. "Comparison of Brain Natriuretic Peptide and Probrain Natriuretic Peptide in the Diagnosis of Cardiogenic Pulmonary Edema in Patients Aged 65 and Older." Journal of the American Geriatrics Society, vol. 53, no. 4, 2005, pp. 643-8.
Ray P, Arthaud M, Birolleau S, et al. Comparison of brain natriuretic peptide and probrain natriuretic peptide in the diagnosis of cardiogenic pulmonary edema in patients aged 65 and older. J Am Geriatr Soc. 2005;53(4):643-8.
Ray, P., Arthaud, M., Birolleau, S., Isnard, R., Lefort, Y., Boddaert, J., & Riou, B. (2005). Comparison of brain natriuretic peptide and probrain natriuretic peptide in the diagnosis of cardiogenic pulmonary edema in patients aged 65 and older. Journal of the American Geriatrics Society, 53(4), 643-8.
Ray P, et al. Comparison of Brain Natriuretic Peptide and Probrain Natriuretic Peptide in the Diagnosis of Cardiogenic Pulmonary Edema in Patients Aged 65 and Older. J Am Geriatr Soc. 2005;53(4):643-8. PubMed PMID: 15817011.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of brain natriuretic peptide and probrain natriuretic peptide in the diagnosis of cardiogenic pulmonary edema in patients aged 65 and older. AU - Ray,Patrick, AU - Arthaud,Martine, AU - Birolleau,Sophie, AU - Isnard,Richard, AU - Lefort,Yannick, AU - Boddaert,Jacques, AU - Riou,Bruno, PY - 2005/4/9/pubmed PY - 2005/5/28/medline PY - 2005/4/9/entrez SP - 643 EP - 8 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 53 IS - 4 N2 - OBJECTIVES: Differentiating cardiogenic pulmonary edema (CPE) from respiratory causes of dyspnea is difficult in elderly patients. The aim of this study was to compare the usefulness of B-type natriuretic peptide (BNP) and amino-terminal fragment BNP (proBNP), to diagnose CPE in patients aged 65 and older. DESIGN: Prospective study. SETTING: Medical emergency department of a 2,000-bed urban teaching hospital. PARTICIPANTS: Patients aged 65 and older presenting with acute dyspnea and a respiratory rate of 25 breaths/min or greater, a partial pressure of oxygen of 70 mmHg or less, or an oxygen saturation of 92% or less were included. MEASUREMENTS: Rapid BNP and proBNP assays, performed blind at admission, were compared with the final diagnosis (CPE or no CPE) as defined by an expert team. RESULTS: Two hundred two patients (mean age+/-standard deviation 80+/-9) were included; 88 (44%) had CPE. There was a strong correlation between proBNP and BNP values (correlation coefficient=0.91, P<.001). The median BNP and proBNP were higher in the group of patients with CPE (377 vs 74 pg/mL, P<.001, and 3,851 vs 495 pg/mL, P<.001, respectively). The best threshold values of BNP and proBNP were 250 pg/mL and 1,500 pg/mL, respectively. The area under the receiver operating characteristic curve was greater with BNP than with proBNP (0.85 vs 0.80, P<.05). BNP assay was more accurate in diagnosis than the emergency physician, whereas proBNP was not. Higher values of BNP and proBNP were associated with greater in-hospital mortality. CONCLUSION: BNP assay is a more useful diagnostic indicator for CPE than proBNP in patients aged 65 and older. SN - 0002-8614 UR - https://www.unboundmedicine.com/medline/citation/15817011/Comparison_of_brain_natriuretic_peptide_and_probrain_natriuretic_peptide_in_the_diagnosis_of_cardiogenic_pulmonary_edema_in_patients_aged_65_and_older_ L2 - https://doi.org/10.1111/j.1532-5415.2005.53213.x DB - PRIME DP - Unbound Medicine ER -