Izvorni znanstveni članak
Combination of Quantitative Capnometry, N-Terminal Pro-brain Natriuretic Peptide, and Clinical Assessment in Differentiating Acute Heart Failure from Pulmonary Disease as Cause of Acute Dyspnea in Pre-hospital Emergency Setting: Study of Diagnostic Accuracy
Petra Klemen
; Center for Emergency Medicine Maribor, Maribor , Slovenia
Mirjam Golub
; Center for Emergency Medicine Maribor, Maribor , Slovenia
Štefek Grmec
; Department of Family Medicine, University of Ljubljana School of Medicine, Ljubljana, Slovenia
Sažetak
Aim To determine the diagnostic accuracy of the combination of quantitative
capnometry (QC), N-terminal pro-brain natriuretic peptide (NT-proBNP), and
clinical assessment in differentiating heart failure (HF)-related acute dyspnea
from pulmonary-related acute dyspnea in a pre-hospital setting.
Methods This prospective study was performed in the Center for Emergency
Medicine Maribor, Slovenia, January 2005 – June 2007. Two groups of patients
with acute dyspnea apnea were compared: HF-related acute dyspnea group
(n = 238) vs pulmonary-related acute dyspnea (asthma/COPD) group (n = 203).
The primary outcome was the comparison of combination of QC, NT-proBNP,
and clinical assessment vs NT-proBNP alone or NT-proBNP in combination with
clinical assessment, in differentiating HF-related acute dyspnea from pulmonary-
related acute dyspnea (asthma/COPD) in pre-hospital emergency setting,
using the area under the receiver operating characteristic curve (AUROC). The
secondary outcomes end points were identification of independent predictors
for final diagnosis of acute dyspnea (caused by acute HF or pulmonary diseases),
and determination of NT-proBNP levels, as well as capnometry, in the subgroup
of patients with a previous history of HF and in the subgroup of patients
with a previous history of pulmonary disease.
Results In differentiating between cardiac and respiratory causes of acute dyspnea
in pre-hospital emergency setting, NT-proBNP in combination with PetCO2
and clinical assessment (AUROC, 0.97; 95% confidence interval [CI], 0.90-0.99)
was superior to combination of NT-proBNP and clinical assessment (AUROC,
0.94; 95% CI, 0.88-0.96; P = 0.006) or NT-proBNP alone (AUROC, 0.90; 95% CI, 0.85-
0.94; P = 0.005). The values of NT-proBNP≥2000 pg/mL and PetCO2 ≤ 4 kPa were
strong independent predictors for acute HF. In the group of acute HF dyspneic
patients, subgroup of patients with previous COPD/asthma had significantly
higher PetCO2 (3.8 ± 1.2 vs 5.8 ± 1.3 kPa, P = 0.009). In the group of COPD/asthma
dyspneic patients, NT-proBNP was significantly higher in the subgroup of patients
with previous HF (1453.3 ± 552.3 vs 741.5 ± 435.5 pg/mL, P = 0.010).
Conclusion In differentiating between cardiac and respiratory causes of acute
dyspnea in pre-hospital emergency setting, NT-proBNP in combination with
capnometry and clinical assessment was superior to NT-proBNP alone or NTproBNP
in combination with clinical assessment.
Ključne riječi
acute dyspnea; prehospital differentiation; quantitative capnometry; N-terminal pro-brain natriuretic peptide
Hrčak ID:
38722
URI
Datum izdavanja:
15.4.2009.
Posjeta: 1.417 *