Effect of renal failure on N-terminal pro-brain natriuretic peptide in patients admitted to emergency department with acute dyspnea
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Date
2014
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Abstract
Objective: Preexisting renal failure diminishes the excretion of N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP), therefore limits the diagnostic value of this peptide for concomitant heart failure. The aim of this study was to evaluate the association between NT-proBNP and the stages of renal dysfunction in a typical population attended to emergency department with acute dyspnea.; Methods: In this cross-sectional study, all consecutive patients with acute dyspnea underwent clinical evaluation, laboratory assessment of NT-proBNP, and echocardiographic examinations. Among subjects, 54.5% were diagnosed as heart failure. Grouping variables according to renal function capacity and ejection fraction, independent variables were compared with Kruskal-Wallis or ANOVA with posthoc tests. Correlation and linear regression analysis were done to analyze the variables associated with NT-proBNP. The diagnostic performance of NT-proBNP was evaluated by receiver-operating characteristic (ROC) curve. ; Results: Serum median NT-proBNP level in patients with severe renal impairment was significantly higher than moderate and mildly decreased renal functions (p=0.001). In patients with moderate and severe left ventricular failure, NT-proBNP was significantly higher compared with normal subjects (LVEF>50%) (p=0.040, and 0.017, respectively). Renal dysfunction was associated in 56% of patients with heart failure. The area under the ROC curve of NT-proBNP for identifying left ventricular failure in patients with renal failure (eGFR<90 mL/min/1.73 m2) was 0.649 and reached significant difference (95% CI:0.548-0.749, p=0.005).; Conclusion: In addition to NT-proBNP measurement in clinical judgement of heart failure, renal functions have to be taken into consideration to avoid misdiagnosis. ©Copyright 2014 by Turkish Society of Cardiology.
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Keywords
Biomarkers , Cross-Sectional Studies , Dyspnea , Echocardiography , Emergency Service, Hospital , Female , Heart Failure , Humans , Male , Natriuretic Peptide, Brain , Patient Admission , Peptide Fragments , Predictive Value of Tests , Renal Insufficiency , ROC Curve , amino terminal pro brain natriuretic peptide , creatine kinase MB , creatinine , hemoglobin , nitrogen , troponin I , urea , biological marker , brain natriuretic peptide , peptide fragment , pro-brain natriuretic peptide (1-76) , aged , Article , cross-sectional study , diagnostic value , disease association , disease severity , dyspnea , echocardiography , emergency ward , enzyme immunoassay , female , glomerulus filtration rate , heart failure , heart left ventricle ejection fraction , hospital admission , human , kidney failure , kidney function , major clinical study , male , middle aged , questionnaire , sensitivity and specificity , blood , complication , dyspnea , echography , emergency health service , evaluation study , heart failure , kidney failure , predictive value , receiver operating characteristic