N-terminal pro-B-type Natriuretic Peptides’ Prognostic Utility Is Overestimated in Meta-analyses Using Study-specific Optimal Diagnostic Thresholds

BACKGROUND:N-terminal fragment B-type natriuretic peptide (NT-proBNP) prognostic utility is commonly determined post hoc by identifying a single optimal discrimination threshold tailored to the individual study population. The authors aimed to determine how using these study-specific post hoc thresh...

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Veröffentlicht in:Anesthesiology (Philadelphia) 2015-08, Vol.123 (2), p.264-271
Hauptverfasser: Potgieter, Danielle, Simmers, Dale, Ryan, Lisa, Biccard, Bruce M, Lurati-Buse, Giovanna A, Cardinale, Daniela M, Chong, Carol P W, Cnotliwy, Miloslaw, Farzi, Sylvia I, Jankovic, Radmilo J, Lim, Wen Kwang, Mahla, Elisabeth, Manikandan, Ramaswamy, Oscarsson, Anna, Phy, Michael P, Rajagopalan, Sriram, Van Gaal, William J, Waliszek, Marek, Rodseth, Reitze N
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Sprache:eng
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Zusammenfassung:BACKGROUND:N-terminal fragment B-type natriuretic peptide (NT-proBNP) prognostic utility is commonly determined post hoc by identifying a single optimal discrimination threshold tailored to the individual study population. The authors aimed to determine how using these study-specific post hoc thresholds impacts meta-analysis results. METHODS:The authors conducted a systematic review of studies reporting the ability of preoperative NT-proBNP measurements to predict the composite outcome of all-cause mortality and nonfatal myocardial infarction at 30 days after noncardiac surgery. Individual patient-level data NT-proBNP thresholds were determined using two different methodologies. First, a single combined NT-proBNP threshold was determined for the entire cohort of patients, and a meta-analysis conducted using this single threshold. Second, study-specific thresholds were determined for each individual study, with meta-analysis being conducted using these study-specific thresholds. RESULTS:The authors obtained individual patient data from 14 studies (n = 2,196). Using a single NT-proBNP cohort threshold, the odds ratio (OR) associated with an increased NT-proBNP measurement was 3.43 (95% CI, 2.08 to 5.64). Using individual study-specific thresholds, the OR associated with an increased NT-proBNP measurement was 6.45 (95% CI, 3.98 to 10.46). In smaller studies (
ISSN:0003-3022
1528-1175
1528-1175
DOI:10.1097/ALN.0000000000000728