Evaluation of mid-regional pro-atrial natriuretic peptide, procalcitonin, and mid-regional pro-adrenomedullin for the diagnosis and risk stratification of dyspneic ED patients
| Autor: | Mehmet Yokuşoğlu, Michael Meisner, Orhan Cinar, Bilgin Comert, Ayhan Yahya Acar, Sukru Ardic, Cumhur Bilgi, Erdem Cevik, Cengiz Kaya, Troy Madsen |
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| Rok vydání: | 2012 |
| Předmět: |
Calcitonin
Male medicine.medical_specialty Exacerbation medicine.drug_class Calcitonin Gene-Related Peptide Risk Assessment Sensitivity and Specificity Likelihood ratios in diagnostic testing Procalcitonin Adrenomedullin Internal medicine Natriuretic peptide Humans Medicine Prospective Studies Protein Precursors Prospective cohort study Aged Heart Failure business.industry Mortality rate General Medicine Odds ratio medicine.disease Peptide Fragments Surgery Dyspnea Heart failure Emergency Medicine Female Emergency Service Hospital business Atrial Natriuretic Factor Biomarkers |
| Zdroj: | The American Journal of Emergency Medicine. 30:1915-1920 |
| ISSN: | 0735-6757 |
| DOI: | 10.1016/j.ajem.2012.04.009 |
| Popis: | Objective The aim of this study was to evaluate the diagnostic and the prognostic value of a laboratory panel consisting of mid-regional pro-atrial natriuretic peptide (MR-proANP), procalcitonin (PCT), and mid-regional pro-adrenomedullin (MR-proADM) for patients presenting to the emergency department (ED) with acute dyspnea. Methods We prospectively enrolled ED patients who presented with a chief complaint of dyspnea and who had an uncertain diagnosis after physician evaluation. Final primary diagnosis of the cause of shortness of breath was confirmed through additional testing per physician discretion. We recorded inpatient admission and 30-day mortality rates. Results One hundred fifty-four patients were enrolled in the study. Congestive heart failure exacerbation was the final primary diagnosis in 42.2% of patients, while infectious etiology was diagnosed in 33.1% of patients. For the diagnosis of congestive heart failure exacerbation, MR-proANP had a sensitivity of 92.7% and specificity of 36.8%, with a negative likelihood ratio (LR−) of 0.16 and a positive likelihood ratio (LR+) of 1.44 (cut-off value: 120 pmol/L). For the diagnosis of an infectious etiology, PCT had a 96.5% specificity and 48.8% sensitivity (LR−: 0.58, LR+: 13.8, cutoff value: 0.25 ng/mL). As a prognostic indicator, MR-proADM demonstrated similar values: odds ratio for 30-day mortality was 8.5 (95% CI, 2.5-28.5, cutoff value: 1.5 nmol/L) and the area under the receiver operating characteristic curve in predicting mortality was 0.81 (95% CI, 0.71-0.91). Conclusion The good negative LR− of MR-proANP and the good positive LR+ of PCT may suggest a role for these markers in the early diagnosis of ED patients with dyspnea. Furthermore, MR-proADM may assist in risk stratification and prognosis in these patients.. |
| Databáze: | OpenAIRE |
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