Brain natriuretic peptide measurement showed poor discriminative ability for diagnosing cardiac versus respiratory aetiology in very old patients with acute dyspnoea (AUC 0.68; 95% CI 0.62-0.73).
Observational (n=383)
Blinded assessors
Does BNP measurement improve the diagnostic discrimination of heart failure in very elderly patients hospitalized for acute dyspnea?
In very elderly patients (≥80 years) with acute dyspnea, BNP measurement has poor discriminative ability and does not significantly improve the clinical differentiation between cardiac and respiratory etiologies.
Effect estimate: AUC 0.68 (95% CI 0.62-0.73)
AIMS: To evaluate the interest of brain natriuretic peptide (BNP) for heart failure (HF) diagnosis in very old patients. METHODS AND RESULTS: A total of 383 patients aged 80 years or older, hospitalized in geriatrics care for dyspnoea, had a BNP measurement at the acute phase. Independent cardiologists blinded to BNP values classified the patients into cardiac vs. respiratory aetiology according to the European Society of Cardiology guidelines. Mean (SD) age was 88.5 (5.4) years, 66% (n = 254) of patients were women, 62% (n = 238) had cardiac dyspnoea and 38% (n = 145) had respiratory dyspnoea. The BNP levels were significantly higher in the cardiac group (median = 385.5 ng/L, interquartile range = 174.0-842.0) than in the respiratory group (median = 172.0 ng/L, interquartile range = 70.8-428.0; P < 0.001). On its own, BNP showed poor discriminative ability area under the curve (AUC) = 0.68; 95% confidence interval (CI) 0.62-0.73 for the diagnostic. In multivariate analysis, BNP remained independently associated with the cardiac aetiology after full-adjustment (odds ratio 1 log increase = 1.87; 95% CI 1.28-2.74), but did not improve the discrimination between the cardiac and the respiratory aetiologies (ΔAUC = 0.013, P = 0.16). In addition, although adding BNP to the other predictive covariates yielded a significant continuous NRI of 57.8% (95% CI 31.2-83.5%), the mean changes in individual predicted probabilities were too low (<3%) to be clinically relevant. CONCLUSION: In this population of very old patients with acute dyspnoea, despite being independently associated with the cardiac aetiology, BNP was not useful for better discriminating cardiac vs. respiratory origin.
Plichart et al. (2016) conducted an observational in Acute dyspnoea (n=383). Brain natriuretic peptide (BNP) measurement was evaluated on Discriminative ability for cardiac vs. respiratory aetiology (AUC 0.68, 95% CI 0.62-0.73). Brain natriuretic peptide measurement showed poor discriminative ability for diagnosing cardiac versus respiratory aetiology in very old patients with acute dyspnoea (AUC 0.68; 95% CI 0.62-0.73).