Key result
Age-dependent NT-proBNP thresholds improve acute HF diagnostic accuracy over fixed cutoffs, reaching AUC ~0.84.
Why the study?
Optimal NT-proBNP thresholds for diagnosing acute heart failure in dyspneic emergency department patients remain uncertain across different patient subgroups.
What is the diagnostic accuracy of fixed versus age-dependent NT-proBNP thresholds for diagnosing acute heart failure in dyspneic emergency department patients?
Meta-Analysis (n=26,948)
What is the diagnostic accuracy of fixed versus age-dependent NT-proBNP thresholds for diagnosing acute heart failure in dyspneic emergency department patients?
Effect estimate: AUC 0.84 (95% CI 0.83-0.85)
Absolute Event Rate: 0.84% vs 0.73%
A fixed NT-proBNP threshold ≤300 ng/L provides excellent performance for ruling out acute heart failure, while age-dependent thresholds offer superior diagnostic accuracy for ruling it in among dyspneic emergency department patients.
Age-dependent NT-proBNP thresholds improve acute HF diagnosis; confirms superior accuracy over fixed cutoffs and supports guideline adoption.
BACKGROUND: Concentrations of N-terminal pro-B type natriuretic peptide (NT-proBNP) is central to acute heart failure (AHF) diagnosis in dyspneic emergency departments (ED) patients, but optimal thresholds remain uncertain. This study aimed to evaluate the diagnostic accuracy of various NT-proBNP thresholds for AHF, across the general population and these key subgroups. METHODS: A systematic review and meta-analysis were conducted, including studies published up to August 28, 2025, that reported the diagnostic performance of NT-proBNP thresholds for AHF in dyspneic ED patients. RESULTS: The analysis included 31 studies comprising 26,948 patients. To exclude AHF, a fixed threshold of ≤300 ng/L yielded an area under the receiver operator characteristic curve (AUC) of 0.73 (0.69-0.77), with high sensitivity of 97.9% (96.9-98.5) and lower specificity of 46.2% (36.4-56.2); the negative predictive value of this threshold was 97.0% (96.5-97.4). Age-dependent thresholds (≥450 ng/L for patients aged <50 years, ≥900 ng/L for those aged 50-75 years, and ≥1,800 ng/L for those aged ≥75 years), evaluated in 14,410 patients, achieved an AUC of 0.84 (0.83-0.85) with a more favorable balance between sensitivity of 85.9% (85.0-86.7) and specificity of 82.0% (81.2-82.9). In patients with CKD (N=2,271), all fixed thresholds yielded AUC <0.80; age-dependent thresholds showed an AUC of 0.77 (0.75-0.78) with specificity of 62.6% (59.4-65.7). In patients with obesity (body mass index ≥30), only age-dependent thresholds were assessed, in 3,562 patients; AUC was 0.82 (0.81-0.84) and sensitivity was 81.2% (79.2-83.1), broadly comparable to the overall population. CONCLUSION: A threshold ≤300 ng/L provides excellent rule-out performance for AHF, while age-dependent NT-proBNP thresholds offer superior diagnostic performance for ruling in AHF in the ED compared to fixed thresholds, and demonstrate consistent accuracy across subgroups. However, evidence in patients with CKD and obesity remains limited, both in terms of sample size and the range of thresholds evaluated.
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Baudry et al. (2026) conducted a meta-analysis in Acute heart failure in dyspneic patients (n=26,948). Age-dependent NT-proBNP thresholds vs. Fixed NT-proBNP threshold (≤300 ng/L) was evaluated on Area under the receiver operator characteristic curve (AUC) for AHF diagnosis (AUC 0.84, 95% CI 0.83-0.85). Age-dependent NT-proBNP thresholds showed superior diagnostic accuracy for acute heart failure (AUC 0.84; 95% CI 0.83-0.85) compared to a fixed threshold of ≤300 ng/L (AUC 0.73).
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