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Brain natriuretic peptide usefulness in very elderly dyspnoeic patients: the BED study.
- Source :
-
European journal of heart failure [Eur J Heart Fail] 2017 Apr; Vol. 19 (4), pp. 540-548. Date of Electronic Publication: 2016 Dec 26. - Publication Year :
- 2017
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Abstract
- Aims: To evaluate the interest of brain natriuretic peptide (BNP) for heart failure (HF) diagnosis in very old patients.<br />Methods and Results: A total of 383 patients aged 80 years or older, hospitalized in geriatrics care for dyspnoea, had a BNP measurement at the acute phase. Independent cardiologists blinded to BNP values classified the patients into cardiac vs. respiratory aetiology according to the European Society of Cardiology guidelines. Mean (SD) age was 88.5 (5.4) years, 66% (n = 254) of patients were women, 62% (n = 238) had cardiac dyspnoea and 38% (n = 145) had respiratory dyspnoea. The BNP levels were significantly higher in the cardiac group (median = 385.5 ng/L, interquartile range = 174.0-842.0) than in the respiratory group (median = 172.0 ng/L, interquartile range = 70.8-428.0; P < 0.001). On its own, BNP showed poor discriminative ability [area under the curve (AUC) = 0.68; 95% confidence interval (CI) 0.62-0.73] for the diagnostic. In multivariate analysis, BNP remained independently associated with the cardiac aetiology after full-adjustment (odds ratio 1 log increase = 1.87; 95% CI 1.28-2.74), but did not improve the discrimination between the cardiac and the respiratory aetiologies (ΔAUC = 0.013, P = 0.16). In addition, although adding BNP to the other predictive covariates yielded a significant continuous NRI of 57.8% (95% CI 31.2-83.5%), the mean changes in individual predicted probabilities were too low (<3%) to be clinically relevant.<br />Conclusion: In this population of very old patients with acute dyspnoea, despite being independently associated with the cardiac aetiology, BNP was not useful for better discriminating cardiac vs. respiratory origin.<br /> (© 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology.)
- Subjects :
- Aged, 80 and over
Diagnosis, Differential
Dyspnea diagnosis
Dyspnea etiology
Female
Heart Failure complications
Heart Failure diagnosis
Humans
Male
Multivariate Analysis
Odds Ratio
Respiratory Tract Diseases complications
Respiratory Tract Diseases diagnosis
Dyspnea blood
Heart Failure blood
Natriuretic Peptide, Brain blood
Respiratory Tract Diseases blood
Subjects
Details
- Language :
- English
- ISSN :
- 1879-0844
- Volume :
- 19
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- European journal of heart failure
- Publication Type :
- Academic Journal
- Accession number :
- 28025867
- Full Text :
- https://doi.org/10.1002/ejhf.699