Department of Intensive Care, Austin Hospital, Melbourne, Australia.
Resuscitation. 2012 Sep;83(9):1119-23. doi: 10.1016/j.resuscitation.2012.02.012. Epub 2012 Feb 19.
To estimate the prognostic value of point-of-care measurement of biomarkers related to dyspnea in patients receiving a medical emergency team (MET) review.
Prospective observational study.
University affiliated hospital.
Cohort of 95 patients receiving MET review over a six month period.
We used a commercial multi-biomarker panel for shortness-of-breath (SOB panel) (Biosite Triage Profiler, Biosite Incorporated®), 9975 Summers Ridge Road, San Diego, CA 92121, USA) including Brain natriuretic peptide (BNP), D-dimer, myoglobin (Myo), creatine kinase MB isoenzyme (CK-MB) and troponin I (Tn-I). We recorded information about demographics, MET review triggers, and MET procedures and patient outcome.
Mean age was 70.5 (±15) years, 38 (41%) patients had a history of chronic heart failure (CHF) and 67 (70%) chronic kidney disease (CKD). At MET activation, 42 (44%) patients were dyspneic. The multi-biomarker panel was positive for at least one marker in 48 (51%) cases. BNP and D-dimer had a sensitivity of 0.79 and 0.93 for ICU admission with a negative predictive value (NPV) of 0.89 and 0.92 respectively. Thirty-five (37%) patients died. BNP was positive in 85% of such cases with sensitivity and NPV of 0.86 and 0.82, respectively. D-dimer was positive in 77% of non-survivors with a sensitivity and NPV of 0.94 and 0.88, respectively. BNP (area under the curve of receiver operating characteristic curve--AUC-ROC: 0.638) and D-dimer (AUC-ROC: 0.574) achieved poor discrimination of subsequent death. Similar findings applied to ICU admission. The combination of normal BNP and D-dimer levels completely ruled out ICU admission or death. The cardiac part of the panel was not useful in predicting ICU admission or mortality.
Although, BNP and D-dimer are poor discriminants of ICU admission and hospital mortality, normal BNP and D-dimer levels practically exclude subsequent need for ICU admission and hospital mortality.
评估床边即时检测与呼吸困难相关的生物标志物在接受医疗急救团队（MET）评估的患者中的预后价值。
前瞻性观察性研究。
大学附属医院。
在六个月期间接受 MET 评估的 95 名患者的队列。
我们使用了一种商业性的短气（SOB）多生物标志物检测试剂盒（Biosite Triage Profiler，Biosite Incorporated®），包括脑利钠肽（BNP）、D-二聚体、肌红蛋白（Myo）、肌酸激酶 MB 同工酶（CK-MB）和肌钙蛋白 I（Tn-I）。我们记录了有关人口统计学、MET 审查触发因素和 MET 程序以及患者结局的信息。
平均年龄为 70.5（±15）岁，38（41%）例患者有慢性心力衰竭（CHF）病史，67（70%）例有慢性肾脏病（CKD）病史。在 MET 激活时，42（44%）例患者呼吸困难。多生物标志物试剂盒至少有一种标志物呈阳性的有 48（51%）例。BNP 和 D-二聚体对 ICU 入院的敏感性分别为 0.79 和 0.93，阴性预测值（NPV）分别为 0.89 和 0.92。35（37%）例患者死亡。85%的此类病例 BNP 阳性，其敏感性和 NPV 分别为 0.86 和 0.82。非幸存者中 D-二聚体阳性的比例为 77%，其敏感性和 NPV 分别为 0.94 和 0.88。BNP（受试者工作特征曲线下面积--AUC-ROC：0.638）和 D-二聚体（AUC-ROC：0.574）在预测随后的死亡方面表现不佳。类似的发现适用于 ICU 入院。正常的 BNP 和 D-二聚体水平完全排除了 ICU 入院和死亡的可能性。试剂盒的心脏部分对预测 ICU 入院或死亡率没有帮助。
尽管 BNP 和 D-二聚体对 ICU 入院和医院死亡率的区分能力较差，但正常的 BNP 和 D-二聚体水平实际上排除了随后需要 ICU 入院和医院死亡率的可能性。
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