Use of N-terminal pro-brain natriuretic peptide to detect cardiac origin in critically ill cancer patients with acute respiratory failure
Objective To assess the accuracy of plasma N-terminal-pro-B-type natriuretic peptide concentrations (NT-proBNP) as a diagnostic tool to recognize acute respiratory failure (ARF) of cardiac origin. Methods Prospective observational study in 100 medical intensive care unit (ICU) patients. NT-proBNP wa...
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| Veröffentlicht in: | Intensive care medicine 2008-05, Vol.34 (5), p.833-839 |
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| creator | Lefebvre, Aurélie Kural-Menasché, Suzanne Darmon, Michael Thiéry, Guillaume Feugeas, Jean-Paul Schlemmer, Benoît Azoulay, Élie |
| description | Objective
To assess the accuracy of plasma N-terminal-pro-B-type natriuretic peptide concentrations (NT-proBNP) as a diagnostic tool to recognize acute respiratory failure (ARF) of cardiac origin.
Methods
Prospective observational study in 100 medical intensive care unit (ICU) patients. NT-proBNP was measured at ICU admission, and diagnosis of cardiac dysfunction was performed using echocardiography.
Results
Sixteen patients had cardiac ARF, 58 patients had noncardiac ARF, and 26 patients were non-ARF controls. Median (IQR) NT-proBNP was 1,951 (617–9,320) pg/ml and was significantly influenced by the level of renal dysfunction. Patients with noncardiac ARF had higher NT-proBNP [1,912 (704–1,922) pg/ml] than non-ARF patients [1,022 (383–2,613) pg/ml], but lower concentrations than cardiac ARF patients [4,536 (1,568–35,171) pg/ml]. The area under the curve (AUC) was 0.663 ± 0.078 (95% confidence interval 0.510–0.815) and was not significantly influenced by the level of renal dysfunction. In addition, using a stepwise logistic regression model, NT-proBNP failed to predict independently the presence of cardiac dysfunction. However, with specificity and negative predictive value of 100%, a NT-proBNP cutoff value of 500 pg/ml seemed useful to rule out cardiac dysfunction. Indeed, none of the 16 patients with cardiac ARF had a NT-proBNP value below 500 pg/ml, whereas it was the case in 8 (30.8%) non-ARF controls and in 12 (20.7%) noncardiac ARF patients.
Conclusions
In cancer patients with ARF, plasma NT-proBNP concentration is not a relevant tool to recognize cardiac dysfunction, but is specific enough to rule out the diagnosis in patients with plasma NT-proBNP concentrations below 500 pg/ml. |
| doi_str_mv | 10.1007/s00134-008-1000-4 |
| format | Article |
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To assess the accuracy of plasma N-terminal-pro-B-type natriuretic peptide concentrations (NT-proBNP) as a diagnostic tool to recognize acute respiratory failure (ARF) of cardiac origin.
Methods
Prospective observational study in 100 medical intensive care unit (ICU) patients. NT-proBNP was measured at ICU admission, and diagnosis of cardiac dysfunction was performed using echocardiography.
Results
Sixteen patients had cardiac ARF, 58 patients had noncardiac ARF, and 26 patients were non-ARF controls. Median (IQR) NT-proBNP was 1,951 (617–9,320) pg/ml and was significantly influenced by the level of renal dysfunction. Patients with noncardiac ARF had higher NT-proBNP [1,912 (704–1,922) pg/ml] than non-ARF patients [1,022 (383–2,613) pg/ml], but lower concentrations than cardiac ARF patients [4,536 (1,568–35,171) pg/ml]. The area under the curve (AUC) was 0.663 ± 0.078 (95% confidence interval 0.510–0.815) and was not significantly influenced by the level of renal dysfunction. In addition, using a stepwise logistic regression model, NT-proBNP failed to predict independently the presence of cardiac dysfunction. However, with specificity and negative predictive value of 100%, a NT-proBNP cutoff value of 500 pg/ml seemed useful to rule out cardiac dysfunction. Indeed, none of the 16 patients with cardiac ARF had a NT-proBNP value below 500 pg/ml, whereas it was the case in 8 (30.8%) non-ARF controls and in 12 (20.7%) noncardiac ARF patients.
Conclusions
In cancer patients with ARF, plasma NT-proBNP concentration is not a relevant tool to recognize cardiac dysfunction, but is specific enough to rule out the diagnosis in patients with plasma NT-proBNP concentrations below 500 pg/ml.</description><identifier>ISSN: 0342-4642</identifier><identifier>EISSN: 1432-1238</identifier><identifier>DOI: 10.1007/s00134-008-1000-4</identifier><identifier>PMID: 18214439</identifier><identifier>CODEN: ICMED9</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer-Verlag</publisher><subject>Accuracy ; Acute Disease ; Adult ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Anesthesiology ; Biological and medical sciences ; Biomarkers - blood ; Bronchoscopy ; Cancer ; Case-Control Studies ; Critical Care Medicine ; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care ; Emergency Medicine ; Female ; Heart failure ; Heart Failure - diagnosis ; Heart Failure - etiology ; Humans ; Intensive ; Intensive care ; Intensive care medicine ; Logistic Models ; Male ; Medical sciences ; Medicine ; Medicine & Public Health ; Middle Aged ; Natriuretic Peptide, Brain - blood ; Neoplasms - complications ; Observational studies ; Original ; Pain Medicine ; Pediatrics ; Peptide Fragments - blood ; Peptides ; Plasma ; Pneumology/Respiratory System ; Prospective Studies ; Respiratory failure ; Respiratory Insufficiency - diagnosis ; Respiratory Insufficiency - etiology ; Sensitivity and Specificity ; Toxicity ; Ventilators</subject><ispartof>Intensive care medicine, 2008-05, Vol.34 (5), p.833-839</ispartof><rights>Springer-Verlag 2008</rights><rights>2008 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c399t-506a3d8e2998b8e20561bd4e5b2d532bd510ce85f2fe5e657020104869c1efef3</citedby><cites>FETCH-LOGICAL-c399t-506a3d8e2998b8e20561bd4e5b2d532bd510ce85f2fe5e657020104869c1efef3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00134-008-1000-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00134-008-1000-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20282588$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18214439$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lefebvre, Aurélie</creatorcontrib><creatorcontrib>Kural-Menasché, Suzanne</creatorcontrib><creatorcontrib>Darmon, Michael</creatorcontrib><creatorcontrib>Thiéry, Guillaume</creatorcontrib><creatorcontrib>Feugeas, Jean-Paul</creatorcontrib><creatorcontrib>Schlemmer, Benoît</creatorcontrib><creatorcontrib>Azoulay, Élie</creatorcontrib><title>Use of N-terminal pro-brain natriuretic peptide to detect cardiac origin in critically ill cancer patients with acute respiratory failure</title><title>Intensive care medicine</title><addtitle>Intensive Care Med</addtitle><addtitle>Intensive Care Med</addtitle><description>Objective
To assess the accuracy of plasma N-terminal-pro-B-type natriuretic peptide concentrations (NT-proBNP) as a diagnostic tool to recognize acute respiratory failure (ARF) of cardiac origin.
Methods
Prospective observational study in 100 medical intensive care unit (ICU) patients. NT-proBNP was measured at ICU admission, and diagnosis of cardiac dysfunction was performed using echocardiography.
Results
Sixteen patients had cardiac ARF, 58 patients had noncardiac ARF, and 26 patients were non-ARF controls. Median (IQR) NT-proBNP was 1,951 (617–9,320) pg/ml and was significantly influenced by the level of renal dysfunction. Patients with noncardiac ARF had higher NT-proBNP [1,912 (704–1,922) pg/ml] than non-ARF patients [1,022 (383–2,613) pg/ml], but lower concentrations than cardiac ARF patients [4,536 (1,568–35,171) pg/ml]. The area under the curve (AUC) was 0.663 ± 0.078 (95% confidence interval 0.510–0.815) and was not significantly influenced by the level of renal dysfunction. In addition, using a stepwise logistic regression model, NT-proBNP failed to predict independently the presence of cardiac dysfunction. However, with specificity and negative predictive value of 100%, a NT-proBNP cutoff value of 500 pg/ml seemed useful to rule out cardiac dysfunction. Indeed, none of the 16 patients with cardiac ARF had a NT-proBNP value below 500 pg/ml, whereas it was the case in 8 (30.8%) non-ARF controls and in 12 (20.7%) noncardiac ARF patients.
Conclusions
In cancer patients with ARF, plasma NT-proBNP concentration is not a relevant tool to recognize cardiac dysfunction, but is specific enough to rule out the diagnosis in patients with plasma NT-proBNP concentrations below 500 pg/ml.</description><subject>Accuracy</subject><subject>Acute Disease</subject><subject>Adult</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Anesthesiology</subject><subject>Biological and medical sciences</subject><subject>Biomarkers - blood</subject><subject>Bronchoscopy</subject><subject>Cancer</subject><subject>Case-Control Studies</subject><subject>Critical Care Medicine</subject><subject>Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care</subject><subject>Emergency Medicine</subject><subject>Female</subject><subject>Heart failure</subject><subject>Heart Failure - diagnosis</subject><subject>Heart Failure - etiology</subject><subject>Humans</subject><subject>Intensive</subject><subject>Intensive care</subject><subject>Intensive care medicine</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Natriuretic Peptide, Brain - blood</subject><subject>Neoplasms - complications</subject><subject>Observational studies</subject><subject>Original</subject><subject>Pain Medicine</subject><subject>Pediatrics</subject><subject>Peptide Fragments - blood</subject><subject>Peptides</subject><subject>Plasma</subject><subject>Pneumology/Respiratory System</subject><subject>Prospective Studies</subject><subject>Respiratory failure</subject><subject>Respiratory Insufficiency - diagnosis</subject><subject>Respiratory Insufficiency - etiology</subject><subject>Sensitivity and Specificity</subject><subject>Toxicity</subject><subject>Ventilators</subject><issn>0342-4642</issn><issn>1432-1238</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kc9qHDEMxk1paLZpH6CXYgrtza3ksb2eYwn9B6G5JGfj8WhSh9mZqe0h7CP0reNllwYKBYEQ_kmyvo-xNwgfEWD7KQNgowSAFbUGoZ6xDapGCpSNfc420CgplFHynL3M-b7SW6PxBTtHK1Gppt2wP7eZ-Dzwn6JQ2sXJj3xJs-iSjxOffElxTVRi4AstJfbEy8x7KhQKDz710Qc-p3hX4RohxYr6cdzzOI4VmAIlvvgSaSqZP8Tyi_uwFuKJ8hKTL3Pa88HHsS55xc4GP2Z6fcoX7Pbrl5vL7-Lq-tuPy89XIjRtW4QG45vekmxb29UE2mDXK9Kd7HUju14jBLJ6kANpMnoLEhCUNW1AGmhoLtiH49x65--VcnG7mAONo59oXrMzLaIxUlbw3T_g_bymqlB2Eo3EFuEA4REKac450eCWFHc-7R2CO5jkjia5atKhBqdqz9vT4LXbUf_UcXKlAu9PgM9VziFVIWP-y0mQVmprKyePXK5P0x2lpx_-f_sjydeq2w</recordid><startdate>20080501</startdate><enddate>20080501</enddate><creator>Lefebvre, Aurélie</creator><creator>Kural-Menasché, Suzanne</creator><creator>Darmon, Michael</creator><creator>Thiéry, Guillaume</creator><creator>Feugeas, Jean-Paul</creator><creator>Schlemmer, Benoît</creator><creator>Azoulay, Élie</creator><general>Springer-Verlag</general><general>Springer</general><general>Springer Nature B.V</general><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>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20080501</creationdate><title>Use of N-terminal pro-brain natriuretic peptide to detect cardiac origin in critically ill cancer patients with acute respiratory failure</title><author>Lefebvre, Aurélie ; Kural-Menasché, Suzanne ; Darmon, Michael ; Thiéry, Guillaume ; Feugeas, Jean-Paul ; Schlemmer, Benoît ; Azoulay, Élie</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c399t-506a3d8e2998b8e20561bd4e5b2d532bd510ce85f2fe5e657020104869c1efef3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Accuracy</topic><topic>Acute Disease</topic><topic>Adult</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Anesthesiology</topic><topic>Biological and medical sciences</topic><topic>Biomarkers - blood</topic><topic>Bronchoscopy</topic><topic>Cancer</topic><topic>Case-Control Studies</topic><topic>Critical Care Medicine</topic><topic>Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care</topic><topic>Emergency Medicine</topic><topic>Female</topic><topic>Heart failure</topic><topic>Heart Failure - diagnosis</topic><topic>Heart Failure - etiology</topic><topic>Humans</topic><topic>Intensive</topic><topic>Intensive care</topic><topic>Intensive care medicine</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Natriuretic Peptide, Brain - blood</topic><topic>Neoplasms - complications</topic><topic>Observational studies</topic><topic>Original</topic><topic>Pain Medicine</topic><topic>Pediatrics</topic><topic>Peptide Fragments - blood</topic><topic>Peptides</topic><topic>Plasma</topic><topic>Pneumology/Respiratory System</topic><topic>Prospective Studies</topic><topic>Respiratory failure</topic><topic>Respiratory Insufficiency - diagnosis</topic><topic>Respiratory Insufficiency - etiology</topic><topic>Sensitivity and Specificity</topic><topic>Toxicity</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lefebvre, Aurélie</creatorcontrib><creatorcontrib>Kural-Menasché, Suzanne</creatorcontrib><creatorcontrib>Darmon, Michael</creatorcontrib><creatorcontrib>Thiéry, Guillaume</creatorcontrib><creatorcontrib>Feugeas, Jean-Paul</creatorcontrib><creatorcontrib>Schlemmer, Benoît</creatorcontrib><creatorcontrib>Azoulay, Élie</creatorcontrib><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>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Intensive care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lefebvre, Aurélie</au><au>Kural-Menasché, Suzanne</au><au>Darmon, Michael</au><au>Thiéry, Guillaume</au><au>Feugeas, Jean-Paul</au><au>Schlemmer, Benoît</au><au>Azoulay, Élie</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Use of N-terminal pro-brain natriuretic peptide to detect cardiac origin in critically ill cancer patients with acute respiratory failure</atitle><jtitle>Intensive care medicine</jtitle><stitle>Intensive Care Med</stitle><addtitle>Intensive Care Med</addtitle><date>2008-05-01</date><risdate>2008</risdate><volume>34</volume><issue>5</issue><spage>833</spage><epage>839</epage><pages>833-839</pages><issn>0342-4642</issn><eissn>1432-1238</eissn><coden>ICMED9</coden><abstract>Objective
To assess the accuracy of plasma N-terminal-pro-B-type natriuretic peptide concentrations (NT-proBNP) as a diagnostic tool to recognize acute respiratory failure (ARF) of cardiac origin.
Methods
Prospective observational study in 100 medical intensive care unit (ICU) patients. NT-proBNP was measured at ICU admission, and diagnosis of cardiac dysfunction was performed using echocardiography.
Results
Sixteen patients had cardiac ARF, 58 patients had noncardiac ARF, and 26 patients were non-ARF controls. Median (IQR) NT-proBNP was 1,951 (617–9,320) pg/ml and was significantly influenced by the level of renal dysfunction. Patients with noncardiac ARF had higher NT-proBNP [1,912 (704–1,922) pg/ml] than non-ARF patients [1,022 (383–2,613) pg/ml], but lower concentrations than cardiac ARF patients [4,536 (1,568–35,171) pg/ml]. The area under the curve (AUC) was 0.663 ± 0.078 (95% confidence interval 0.510–0.815) and was not significantly influenced by the level of renal dysfunction. In addition, using a stepwise logistic regression model, NT-proBNP failed to predict independently the presence of cardiac dysfunction. However, with specificity and negative predictive value of 100%, a NT-proBNP cutoff value of 500 pg/ml seemed useful to rule out cardiac dysfunction. Indeed, none of the 16 patients with cardiac ARF had a NT-proBNP value below 500 pg/ml, whereas it was the case in 8 (30.8%) non-ARF controls and in 12 (20.7%) noncardiac ARF patients.
Conclusions
In cancer patients with ARF, plasma NT-proBNP concentration is not a relevant tool to recognize cardiac dysfunction, but is specific enough to rule out the diagnosis in patients with plasma NT-proBNP concentrations below 500 pg/ml.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer-Verlag</pub><pmid>18214439</pmid><doi>10.1007/s00134-008-1000-4</doi><tpages>7</tpages></addata></record> |
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| ispartof | Intensive care medicine, 2008-05, Vol.34 (5), p.833-839 |
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| language | eng |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Accuracy Acute Disease Adult Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anesthesiology Biological and medical sciences Biomarkers - blood Bronchoscopy Cancer Case-Control Studies Critical Care Medicine Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care Emergency Medicine Female Heart failure Heart Failure - diagnosis Heart Failure - etiology Humans Intensive Intensive care Intensive care medicine Logistic Models Male Medical sciences Medicine Medicine & Public Health Middle Aged Natriuretic Peptide, Brain - blood Neoplasms - complications Observational studies Original Pain Medicine Pediatrics Peptide Fragments - blood Peptides Plasma Pneumology/Respiratory System Prospective Studies Respiratory failure Respiratory Insufficiency - diagnosis Respiratory Insufficiency - etiology Sensitivity and Specificity Toxicity Ventilators |
| title | Use of N-terminal pro-brain natriuretic peptide to detect cardiac origin in critically ill cancer patients with acute respiratory failure |
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