Korenstein Deborah, Wisnivesky Juan P, Wyer Peter, Adler Rhodes, Ponieman Diego, McGinn Thomas
Division of General Internal Medicine, Department of Medicine, Mount Sinai School of Medicine, New York, USA.
BMC Emerg Med. 2007 Jun 26;7:6. doi: 10.1186/1471-227X-7-6.
Dyspnea is a common chief complaint in the emergency department (ED); differentiating heart failure (HF) from other causes can be challenging. Brain Natriuretic Peptide (BNP) is a new diagnostic test for HF for use in dyspneic patients in the ED. The purpose of this study is to systematically review the accuracy of BNP in the emergency diagnosis of HF.
We searched MEDLINE (1975-2005) supplemented by reference tracking. We included studies that reported the sensitivity and specificity of BNP for diagnosing HF in ED patients with acute dyspnea. Two reviewers independently assessed study quality. We pooled sensitivities and specificities within five ranges of BNP cutoffs.
Ten studies including 3,344 participants met inclusion criteria. Quality was variable; possible verification or selection bias was common. No studies eliminated patients with obvious medical causes of dyspnea. Most studies used the Triage BNP assay; all utilized a clinical reference standard. Pooled sensitivity and specificity at a BNP cutoff of 100-105 pg/ml were 90% and 74% with negative likelihood ratio (LR) of 0.14; pooled sensitivity was 81% with specificity of 90% at cutoffs between 300 and 400 pg/ml with positive LR of 7.6.
Our analysis suggests that BNP has moderate accuracy in detecting HF in the ED. Our results suggest utilizing a BNP of less than 100 pg/ml to rule out HF and a BNP of greater than 400 pg/ml to diagnose HF. Many studies were of marginal quality, and all included patients with varying degrees of diagnostic uncertainty. Further studies focusing on patients with diagnostic uncertainty will clarify the real-world utility of BNP in the emergency management of dyspnea.
呼吸困难是急诊科常见的主要症状；区分心力衰竭（HF）与其他病因具有挑战性。脑钠肽（BNP）是一种用于急诊科呼吸困难患者的HF新型诊断检测方法。本研究的目的是系统评价BNP在HF急诊诊断中的准确性。
我们检索了MEDLINE（1975 - 2005年），并辅以参考文献追踪。我们纳入了报告BNP对急诊科急性呼吸困难患者诊断HF的敏感性和特异性的研究。两名评审员独立评估研究质量。我们汇总了BNP临界值五个范围内的敏感性和特异性。
10项研究共3344名参与者符合纳入标准。质量参差不齐；可能存在验证或选择偏倚较为常见。没有研究排除有明显医学原因导致呼吸困难的患者。大多数研究使用分诊BNP检测法；所有研究都采用了临床参考标准。BNP临界值为100 - 105 pg/ml时，汇总敏感性和特异性分别为90%和74%，阴性似然比（LR）为0.14；临界值在300至400 pg/ml之间时，汇总敏感性为81%，特异性为90%，阳性LR为7.6。
我们的分析表明，BNP在急诊科检测HF方面具有中等准确性。我们的结果表明，使用低于100 pg/ml的BNP排除HF，高于400 pg/ml的BNP诊断HF。许多研究质量一般，且所有研究都纳入了诊断不确定性程度不同的患者。进一步针对诊断不确定患者的研究将阐明BNP在呼吸困难急诊管理中的实际应用价值。
