Health Technology & Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands.
Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands.
Int J Chron Obstruct Pulmon Dis. 2024 Feb 23;19:531-541. doi: 10.2147/COPD.S437899. eCollection 2024.
Due to shared symptoms, acute heart failure (AHF) is difficult to differentiate from an acute exacerbation of COPD (AECOPD). This systematic review aimed to identify markers that can diagnose AHF underlying acute dyspnea in patients with COPD presenting at the hospital.
All types of observational studies and clinical trials that investigated any marker's ability to diagnose AHF in acutely dyspneic COPD patients were considered eligible for inclusion. An AI tool (ASReview) supported the title and abstract screening of the articles obtained from PubMed, Scopus, Web of Science, the Cochrane Library, Embase, and CINAHL until April 2023. Full text screening was independently performed by two reviewers. Twenty percent of the data extraction was checked by a second reviewer and the risk of bias was assessed in duplicate using the QUADAS-2 tool. Markers' discriminative abilities were evaluated in terms of sensitivity, specificity, positive and negative predictive values, and the area under the curve when available.
The search identified 10,366 articles. After deduplication, title and abstract screening was performed on 5,386 articles, leaving 153 relevant, of which 82 could be screened full text. Ten distinct studies (reported in 16 articles) were included, of which 9 had a high risk of bias. Overall, these studies evaluated 12 distinct laboratory and 7 non-laboratory markers. BNP, NT-proBNP, MR-proANP, and inspiratory inferior vena cava diameter showed the highest diagnostic discrimination.
There is not much evidence for the use of markers to diagnose AHF in acutely dyspneic COPD patients in the hospital setting. BNPs seem most promising, but should be interpreted alongside imaging and clinical signs, as this may lead to improved diagnostic accuracy. Future validation studies are urgently needed before any AHF marker can be incorporated into treatment decision-making algorithms for patients with COPD.
CRD42022283952.
由于症状相似，急性心力衰竭（AHF）很难与 COPD 急性加重（AECOPD）相区分。本系统评价旨在确定可用于诊断因急性呼吸困难而住院的 COPD 患者基础 AHF 的标志物。
所有类型的观察性研究和临床试验，只要研究了任何标志物在急性呼吸困难 COPD 患者中诊断 AHF 的能力，均被认为符合纳入标准。一种人工智能工具（ASReview）支持从 PubMed、Scopus、Web of Science、Cochrane 图书馆、Embase 和 CINAHL 获得的文章的标题和摘要筛选，直到 2023 年 4 月。两名评审员独立进行全文筛选。数据提取的 20%由第二名评审员检查，使用 QUADAS-2 工具重复评估偏倚风险。在有条件的情况下，使用敏感度、特异度、阳性和阴性预测值以及曲线下面积来评估标志物的鉴别能力。
搜索共确定了 10366 篇文章。经过去重，对 5386 篇文章进行了标题和摘要筛选，留下 153 篇相关文章，其中 82 篇可进行全文筛选。纳入了 10 项不同的研究（报告了 16 篇文章），其中 9 项研究存在较高的偏倚风险。总的来说，这些研究评估了 12 种不同的实验室和 7 种非实验室标志物。BNP、NT-proBNP、MR-proANP 和吸气时下腔静脉直径显示出最高的诊断区分度。
在医院环境中，用于诊断因急性呼吸困难而住院的 COPD 患者基础 AHF 的标志物证据有限。BNP 似乎最有希望，但应与影像学和临床体征一起解读，因为这可能会提高诊断准确性。在任何 AHF 标志物可被纳入 COPD 患者的治疗决策算法之前，迫切需要进行未来的验证研究。
CRD42022283952。
