N-terminal prohormone of brain natriuretic peptide: a useful tool for the detection of acute pulmonary artery embolism in post-surgical patients
Acute pulmonary embolism (APE) is an important clinical problem in patients after major surgery and often remains a difficult diagnosis because of unspecific clinical symptoms. Therefore, we investigated the role of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) for the detection of...
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| Veröffentlicht in: | British journal of anaesthesia : BJA 2012-12, Vol.109 (6), p.907-910 |
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| creator | Winkler, B.E. Schuetz, W. Froeba, G. Muth, C.-M. |
| description | Acute pulmonary embolism (APE) is an important clinical problem in patients after major surgery and often remains a difficult diagnosis because of unspecific clinical symptoms. Therefore, we investigated the role of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) for the detection of APE.
In 44 patients with suspected APE referred to the intensive care unit after major surgery, serum NT-proBNP, troponin-I, and D-dimers were measured according to the standard hospital protocol. To definitively confirm or exclude APE, all patients underwent an angiographic CT scan of the thorax.
APE was confirmed in 28 and excluded in 16 patients by CT scan. NT-proBNP was significantly (P |
| doi_str_mv | 10.1093/bja/aes315 |
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In 44 patients with suspected APE referred to the intensive care unit after major surgery, serum NT-proBNP, troponin-I, and D-dimers were measured according to the standard hospital protocol. To definitively confirm or exclude APE, all patients underwent an angiographic CT scan of the thorax.
APE was confirmed in 28 and excluded in 16 patients by CT scan. NT-proBNP was significantly (P<0.01) higher in patients with APE [4425 (sd 8826; range 63–35 000) pg ml−1] compared with those without [283 (sd 327; range 13–1133) pg ml−1]. The sensitivity of the NT-proBNP screening was 93%, specificity 63%, positive predictive value 81%, and negative predictive value 83%. There were no significant (P = 0.96) differences in D-dimers between subjects with and without APE [confirmed APE: 511 (sd 207; range 83–750) μg litre−1; excluded APE: 509 (sd 170; range 230–750) μg litre−1]. Troponin-I levels were not elevated in 32% of the patients with APE.
D-dimer levels are frequently elevated in post-surgical patients and not applicable for confirmation or exclusion of APE. In contrast, NT-proBNP appears to be a useful biomarker for APE diagnosis in the postoperative setting. In the case of NT-proBNP levels below the upper reference limit, haemodynamically relevant APE is unlikely. Troponin-I in contrast is not considered to be helpful.</description><identifier>ISSN: 0007-0912</identifier><identifier>EISSN: 1471-6771</identifier><identifier>DOI: 10.1093/bja/aes315</identifier><identifier>PMID: 22991260</identifier><identifier>CODEN: BJANAD</identifier><language>eng</language><publisher>Oxford: Elsevier Ltd</publisher><subject>Acute Disease ; acute pulmonary embolism, APE ; Adult ; Aged ; Aged, 80 and over ; Anesthesia ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Biomarkers - blood ; cardiac biomarker ; D-dimer ; Diagnosis, Differential ; Female ; Fibrin Fibrinogen Degradation Products ; Humans ; lung arterial embolism, LAE LE ; Male ; Medical sciences ; Middle Aged ; N-terminal pro-natriuretric peptide, NT-proBNP ; Natriuretic Peptide, Brain - blood ; Peptide Fragments - blood ; Postoperative Complications - blood ; Postoperative Complications - diagnostic imaging ; pulmonary arterial embolism, PAE ; Pulmonary Artery - diagnostic imaging ; Pulmonary Embolism - blood ; Pulmonary Embolism - diagnostic imaging ; Sensitivity and Specificity ; Tomography, X-Ray Computed - methods</subject><ispartof>British journal of anaesthesia : BJA, 2012-12, Vol.109 (6), p.907-910</ispartof><rights>2012 The Author(s)</rights><rights>The Author [2012]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com 2012</rights><rights>2014 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c428t-aa5c44def713f7575ca79199ee56ec9c7ab6467df5719cce755785689402bc313</citedby><cites>FETCH-LOGICAL-c428t-aa5c44def713f7575ca79199ee56ec9c7ab6467df5719cce755785689402bc313</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27922,27923</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26630932$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22991260$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Winkler, B.E.</creatorcontrib><creatorcontrib>Schuetz, W.</creatorcontrib><creatorcontrib>Froeba, G.</creatorcontrib><creatorcontrib>Muth, C.-M.</creatorcontrib><title>N-terminal prohormone of brain natriuretic peptide: a useful tool for the detection of acute pulmonary artery embolism in post-surgical patients</title><title>British journal of anaesthesia : BJA</title><addtitle>Br J Anaesth</addtitle><addtitle>Br J Anaesth</addtitle><description>Acute pulmonary embolism (APE) is an important clinical problem in patients after major surgery and often remains a difficult diagnosis because of unspecific clinical symptoms. Therefore, we investigated the role of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) for the detection of APE.
In 44 patients with suspected APE referred to the intensive care unit after major surgery, serum NT-proBNP, troponin-I, and D-dimers were measured according to the standard hospital protocol. To definitively confirm or exclude APE, all patients underwent an angiographic CT scan of the thorax.
APE was confirmed in 28 and excluded in 16 patients by CT scan. NT-proBNP was significantly (P<0.01) higher in patients with APE [4425 (sd 8826; range 63–35 000) pg ml−1] compared with those without [283 (sd 327; range 13–1133) pg ml−1]. The sensitivity of the NT-proBNP screening was 93%, specificity 63%, positive predictive value 81%, and negative predictive value 83%. There were no significant (P = 0.96) differences in D-dimers between subjects with and without APE [confirmed APE: 511 (sd 207; range 83–750) μg litre−1; excluded APE: 509 (sd 170; range 230–750) μg litre−1]. Troponin-I levels were not elevated in 32% of the patients with APE.
D-dimer levels are frequently elevated in post-surgical patients and not applicable for confirmation or exclusion of APE. In contrast, NT-proBNP appears to be a useful biomarker for APE diagnosis in the postoperative setting. In the case of NT-proBNP levels below the upper reference limit, haemodynamically relevant APE is unlikely. Troponin-I in contrast is not considered to be helpful.</description><subject>Acute Disease</subject><subject>acute pulmonary embolism, APE</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anesthesia</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Biomarkers - blood</subject><subject>cardiac biomarker</subject><subject>D-dimer</subject><subject>Diagnosis, Differential</subject><subject>Female</subject><subject>Fibrin Fibrinogen Degradation Products</subject><subject>Humans</subject><subject>lung arterial embolism, LAE LE</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>N-terminal pro-natriuretric peptide, NT-proBNP</subject><subject>Natriuretic Peptide, Brain - blood</subject><subject>Peptide Fragments - blood</subject><subject>Postoperative Complications - blood</subject><subject>Postoperative Complications - diagnostic imaging</subject><subject>pulmonary arterial embolism, PAE</subject><subject>Pulmonary Artery - diagnostic imaging</subject><subject>Pulmonary Embolism - blood</subject><subject>Pulmonary Embolism - diagnostic imaging</subject><subject>Sensitivity and Specificity</subject><subject>Tomography, X-Ray Computed - methods</subject><issn>0007-0912</issn><issn>1471-6771</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1rFTEYhYNY7LW68QdINoII0yYzk2TirhS_oNSNrsM7mTc2ZWYy5kPov_AnN5d7tRtxFQjPew7nHEJecXbOme4uxju4AEwdF0_IjveKN1Ip_pTsGGOqYZq3p-R5SneMcdVq8Yyctq2uv5LtyO-bJmNc_Aoz3WK4DXEJK9Lg6BjBr3SFHH2JmL2lG27ZT_ieAi0JXZlpDmGmLkSab5FOmNFmH9b9NdiSkW5lrnIQ7ynEanNPcRnD7NNCq_QWUm5SiT-83ZtD9rjm9IKcOJgTvjy-Z-T7xw_frj43118_fbm6vG5s3w65ARC27yd0indOCSUsKM21RhQSrbYKRtlLNTmhuLYWlRBqEHLQPWtH2_HujLw96NbUPwumbBafLM4zrBhKMpwrPgyS921F3x1QG0NKEZ3Zol9qKsOZ2S9g6gLmsECFXx91y7jg9Bf9U3kF3hwBSDW4i7Banx45Kbsq2T5yoWz_N-wPHNa2fnmMJtnapMXJx7qHmYL_19kDVHSxEA</recordid><startdate>20121201</startdate><enddate>20121201</enddate><creator>Winkler, B.E.</creator><creator>Schuetz, W.</creator><creator>Froeba, G.</creator><creator>Muth, C.-M.</creator><general>Elsevier Ltd</general><general>Oxford University Press</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20121201</creationdate><title>N-terminal prohormone of brain natriuretic peptide: a useful tool for the detection of acute pulmonary artery embolism in post-surgical patients</title><author>Winkler, B.E. ; Schuetz, W. ; Froeba, G. ; Muth, C.-M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c428t-aa5c44def713f7575ca79199ee56ec9c7ab6467df5719cce755785689402bc313</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Acute Disease</topic><topic>acute pulmonary embolism, APE</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anesthesia</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Biomarkers - blood</topic><topic>cardiac biomarker</topic><topic>D-dimer</topic><topic>Diagnosis, Differential</topic><topic>Female</topic><topic>Fibrin Fibrinogen Degradation Products</topic><topic>Humans</topic><topic>lung arterial embolism, LAE LE</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>N-terminal pro-natriuretric peptide, NT-proBNP</topic><topic>Natriuretic Peptide, Brain - blood</topic><topic>Peptide Fragments - blood</topic><topic>Postoperative Complications - blood</topic><topic>Postoperative Complications - diagnostic imaging</topic><topic>pulmonary arterial embolism, PAE</topic><topic>Pulmonary Artery - diagnostic imaging</topic><topic>Pulmonary Embolism - blood</topic><topic>Pulmonary Embolism - diagnostic imaging</topic><topic>Sensitivity and Specificity</topic><topic>Tomography, X-Ray Computed - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Winkler, B.E.</creatorcontrib><creatorcontrib>Schuetz, W.</creatorcontrib><creatorcontrib>Froeba, G.</creatorcontrib><creatorcontrib>Muth, C.-M.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of anaesthesia : BJA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Winkler, B.E.</au><au>Schuetz, W.</au><au>Froeba, G.</au><au>Muth, C.-M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>N-terminal prohormone of brain natriuretic peptide: a useful tool for the detection of acute pulmonary artery embolism in post-surgical patients</atitle><jtitle>British journal of anaesthesia : BJA</jtitle><stitle>Br J Anaesth</stitle><addtitle>Br J Anaesth</addtitle><date>2012-12-01</date><risdate>2012</risdate><volume>109</volume><issue>6</issue><spage>907</spage><epage>910</epage><pages>907-910</pages><issn>0007-0912</issn><eissn>1471-6771</eissn><coden>BJANAD</coden><abstract>Acute pulmonary embolism (APE) is an important clinical problem in patients after major surgery and often remains a difficult diagnosis because of unspecific clinical symptoms. Therefore, we investigated the role of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) for the detection of APE.
In 44 patients with suspected APE referred to the intensive care unit after major surgery, serum NT-proBNP, troponin-I, and D-dimers were measured according to the standard hospital protocol. To definitively confirm or exclude APE, all patients underwent an angiographic CT scan of the thorax.
APE was confirmed in 28 and excluded in 16 patients by CT scan. NT-proBNP was significantly (P<0.01) higher in patients with APE [4425 (sd 8826; range 63–35 000) pg ml−1] compared with those without [283 (sd 327; range 13–1133) pg ml−1]. The sensitivity of the NT-proBNP screening was 93%, specificity 63%, positive predictive value 81%, and negative predictive value 83%. There were no significant (P = 0.96) differences in D-dimers between subjects with and without APE [confirmed APE: 511 (sd 207; range 83–750) μg litre−1; excluded APE: 509 (sd 170; range 230–750) μg litre−1]. Troponin-I levels were not elevated in 32% of the patients with APE.
D-dimer levels are frequently elevated in post-surgical patients and not applicable for confirmation or exclusion of APE. In contrast, NT-proBNP appears to be a useful biomarker for APE diagnosis in the postoperative setting. In the case of NT-proBNP levels below the upper reference limit, haemodynamically relevant APE is unlikely. Troponin-I in contrast is not considered to be helpful.</abstract><cop>Oxford</cop><pub>Elsevier Ltd</pub><pmid>22991260</pmid><doi>10.1093/bja/aes315</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Acute Disease acute pulmonary embolism, APE Adult Aged Aged, 80 and over Anesthesia Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Biomarkers - blood cardiac biomarker D-dimer Diagnosis, Differential Female Fibrin Fibrinogen Degradation Products Humans lung arterial embolism, LAE LE Male Medical sciences Middle Aged N-terminal pro-natriuretric peptide, NT-proBNP Natriuretic Peptide, Brain - blood Peptide Fragments - blood Postoperative Complications - blood Postoperative Complications - diagnostic imaging pulmonary arterial embolism, PAE Pulmonary Artery - diagnostic imaging Pulmonary Embolism - blood Pulmonary Embolism - diagnostic imaging Sensitivity and Specificity Tomography, X-Ray Computed - methods |
| title | N-terminal prohormone of brain natriuretic peptide: a useful tool for the detection of acute pulmonary artery embolism in post-surgical patients |
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