疑似心力衰竭时NT-proBNP与BNP之间的诊断一致性

Diagnostic concordance between NT-proBNP and BNP for suspected heart failure.

作者信息

Farnsworth Christopher W, Bailey Adam L, Jaffe Alan S, Scott Mitchell G

机构信息

Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University, St. Louis, MO, United States.

Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.

出版信息

Clin Biochem. 2018 Sep;59:50-55. doi: 10.1016/j.clinbiochem.2018.07.002. Epub 2018 Jul 6.

DOI:10.1016/j.clinbiochem.2018.07.002

PMID:30111510

Abstract

OBJECTIVES

BNP and NT-proBNP are viewed as comparable in their ability to diagnose and monitor HF in clinical guidelines. However, no recent large-scale study has directly established diagnostic concordance between BNP and NT-proBNP. This study sought to assess diagnostic concordance of BNP and NT-proBNP for ruling in and ruling out heart failure (HF).

METHODS

Simultaneous BNP and NT-proBNP testing was performed on 2729 patient samples with routinely ordered BNP testing. Hospital location, age, sex, creatinine, BNP and NT-proBNP were also recorded. Recommended cutoffs for BNP and NT-proBNP for ruling in and out HF were used for assessing diagnostic concordance and correlation.

RESULTS

In the ED setting, concordance between BNP and NT-proBNP was 0.695 (95% CI, 0.668-0.723) by weighted kappa using the recommended cutoffs for the acute setting. In non-ED patients, the concordance was 0.642 (95% CI, 0.580-0.705) using non-acute setting cutoffs. In the ED setting, patients with eGFR <60 mL/min/1.73m had lower overall concordance (0.626; 95% CI 0.580-0.672) compared to those with eGFR >60 mL/min/1.73m (0.707, 95% CI 0.669-0.744). Patients with an eGFR <15 mL/min/1.73m had a much higher ratio of NT-proBNP to BNP than patients with eGFR >60 mL/min/1.73m (17.0 vs. 4.7, P < .001). Linear regression revealed an r of 0.52 in the ED setting and 0.49 in the non-ED setting between BNP and NT-proBNP. For 368 patients with multiple measurements of natriuretic peptides, 19.7% of paired temporal measurements had an increase in one peptide and a decrease in the other.

CONCLUSION

The current cutoffs for diagnosing HF for NT-proBNP and BNP have relatively low diagnostic concordance and correlation, particularly among patients with chronic kidney disease.

摘要

目的

在临床指南中，B型利钠肽（BNP）和N末端B型利钠肽原（NT-proBNP）在诊断和监测心力衰竭（HF）的能力方面被视为具有可比性。然而，最近尚无大规模研究直接证实BNP和NT-proBNP之间的诊断一致性。本研究旨在评估BNP和NT-proBNP在诊断心力衰竭（HF）时的诊断一致性。

方法

对2729例接受常规BNP检测的患者样本同时进行BNP和NT-proBNP检测。记录医院位置、年龄、性别、肌酐、BNP和NT-proBNP。使用推荐的BNP和NT-proBNP诊断HF的临界值来评估诊断一致性和相关性。

结果

在急诊室环境中，使用急性环境推荐的临界值，通过加权kappa法得出BNP和NT-proBNP之间的一致性为0.695（95%CI，0.668-0.723）。在非急诊患者中，使用非急性环境临界值时，一致性为0.642（95%CI，0.580-0.705）。在急诊室环境中，估算肾小球滤过率（eGFR）<60 mL/min/1.73m²的患者总体一致性（0.626；95%CI 0.580-0.672）低于eGFR>60 mL/min/1.73m²的患者（0.707，95%CI 0.669-0.744）。eGFR<15 mL/min/1.73m²的患者NT-proBNP与BNP的比值比eGFR>60 mL/min/1.73m²的患者高得多（17.0对4.7，P<0.001）。线性回归显示，在急诊室环境中BNP和NT-proBNP之间的r为0.52，在非急诊环境中为0.49。对于368例多次测量利钠肽的患者，19.7%的配对时间测量结果显示一种肽增加而另一种肽减少。