N-Terminal pro B-type natriuretic peptide testing for short-term prognosis in breathless older adults

Chenevier-Gobeaux, Camille; Allo, Jean-Christophe; Arthaud, Martine; Achkar, R.; Claessens, Yan-Eric; Ekindjian, O.G.; Riou, Bruno; Ray, Patrick

doi:10.1016/j.ajem.2007.08.027

« Previous Next »American Journal of Emergency Medicine
Volume 26, Issue 5 , Pages 555-560, June 2008

N-Terminal pro B-type natriuretic peptide testing for short-term prognosis in breathless older adults☆

Camille Chenevier-Gobeaux, MD
- Department of Biochemistry A, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), 27 rue du Faubourg Saint-Jacques, 75679 Paris Cedex 14, France
Jean-Christophe Allo, MD
- Department of Emergency Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), 27 rue du Faubourg Saint-Jacques, 75679 Paris Cedex 14, France
Martine Arthaud, MD
- Laboratory of Emergency Biology, Centre Hospitalo-Universitaire Pitié-Salpêtrière, Assistance-Publique Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie Paris 6, 47-83 boulevard de l'hôpital, 75013 Paris, France
R. Achkar, MD
- Department of Emergency Medicine and Surgery, Centre Hospitalo-Universitaire Pitié-Salpêtrière, Assistance-Publique Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie Paris 6, 47-83 boulevard de l'hôpital, 75013 Paris, France
Yan-Eric Claessens, MD, PhD
- Department of Emergency Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), 27 rue du Faubourg Saint-Jacques, 75679 Paris Cedex 14, France
O.G. Ekindjian, MD, PhD
- Department of Emergency Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), 27 rue du Faubourg Saint-Jacques, 75679 Paris Cedex 14, France
Bruno Riou, MD, PhD
- Department of Emergency Medicine and Surgery, Centre Hospitalo-Universitaire Pitié-Salpêtrière, Assistance-Publique Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie Paris 6, 47-83 boulevard de l'hôpital, 75013 Paris, France
Patrick Ray, MD
- Department of Emergency Medicine and Surgery, Centre Hospitalo-Universitaire Pitié-Salpêtrière, Assistance-Publique Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie Paris 6, 47-83 boulevard de l'hôpital, 75013 Paris, France
- Corresponding author. Service d'Accueil des Urgences, Groupe Hospitalier Pitié-Salpêtrière, 47-83 boulevard de l'hôpital, 75013 Paris, France. Tel.: +33 1 42 17 72 49; fax: +33 1 42 17 72 64.

Received 18 April 2007; received in revised form 23 August 2007; accepted 23 August 2007.

Abstract

Background

Amino-terminal pro–brain natriuretic peptide (NT-proBNP) is useful for the triage of patients with dyspnea. Our aim was to determine whether NT-proBNP levels could predict in-hospital outcome in breathless elderly patients.

Methods

At admission, NT-proBNP plasma concentrations were determined in 324 dyspneic patients aged 75 years and older. The association between NT-proBNP values and in-hospital mortality was assessed.

Results

Median NT-proBNP concentrations were not different in deceased patients (n = 43, 13%) compared to that of survivors (n = 281, 87%) (4354 vs 2499 pg/mL, respectively; P = .06). To predict in-hospital mortality, the optimum threshold of NT-proBNP was 3855 pg/mL, as defined by the receiver operating characteristic (ROC) curve, with a nonsignificant area under the ROC curve of 0.59. Mortality was significantly higher in patients (n = 139) with NT-proBNP levels 3855 pg/mL or higher (17.9% vs 9.7%, P = .045). After multivariate analysis, NT-proBNP level 3855 pg/mL or higher at admission was predictive of mortality (odds ratio, 2.41; 95% confidence interval, 1.02-5.68; P = .04).