Impact of age, race, and sex on the ability of B-type natriuretic peptide to aid in the emergency diagnosis of heart failure: Results from the Breathing Not Properly (BNP) multinational study
Impact of age, race, and sex on the ability of B-type natriuretic peptide to aid in the emergency diagnosis of heart failure: Results from the Breathing Not Properly (BNP) multinational study
复制标题
DOI：
10.1016/j.ahj.2004.01.013
复制
发表时间：
2004-06-01
影响因子：
4.8
通讯作者：
McCullough, PA
中科院分区：
文献类型：
--
作者：
Maisel, AS;Clopton, P;McCullough, PA
背景b型利钠肽（BNP）在心室壁张力增加时分泌。方法呼吸不正常多国研究是一项7个中心的前瞻性研究，纳入1586例因急性呼吸困难而就诊于急诊科的患者，并在到达时用点护理法测量BNP。充血性心力衰竭（CHF）的金标准是由两位独立的心脏病专家裁决的，他们对BNP结果不知情，他们审查了所有的临床数据和标准化评分。目前的研究探讨了这些变量对BNP决策统计的影响，以及改变截止值可能对使用BNP信息的诊断决策的成本效益产生的影响。结果CHF发生率在年龄（P < 0.001）和种族（P = 0.020）的基础上有显著差异，但在性别（P = 0.424）上无显著差异。BNP水平随年龄增加而升高（P < 0.001）。为了评估BNP水平作为人口统计学变量的函数在诊断效用上的潜在差异，我们绘制了单独的受试者工作特征曲线。BNP对年轻受试者的预测作用强于老年受试者，对女性患者的预测作用略弱于男性患者（曲线下面积分别= 0.918和0.870）。白人和黑人之间的差异甚至更小（曲线下面积分别为0.888和0.903）。特异性作为年龄函数的差异大于特异性或敏感性的其他差异。当在多变量方法中使用逻辑回归将人口变量与BNP信息结合起来预测CHF时，只有BNP对急性CHF的预测有显著贡献：当模型扩展到包括每个人口变量与BNP标志相互作用的术语时，发现性别之间存在显著的相互作用。由于假阳性和假阴性的相对后果不太可能相等，因此提出了根据当前数据作为相对成本函数选择的BNP临界值。BNP临界点bbb100 pg/mL时，结果急剧上升。结论：如果假设未能治疗CHF病例比治疗阴性病例更糟糕，那么对于以呼吸困难为主诉的急诊科患者，无论年龄、性别或种族，都应使用相对较低的BNP切点（例如，不低于100 pg/mL）。
Background B-type natriuretic peptide (BNP) is secreted from the cardiac ventricles in response to increased wall tension.Methods The Breathing Not Properly Multinational Study was a 7-center, prospective study of 1586 patients who presented to the Emergency Department with acute dyspnea and had BNP measured with a point-of care assay upon arrival. The gold standard for congestive heart failure (CHF) was adjudicated by two independent cardiologists, blinded to BNP results, who reviewed all clinical data and standardized scores. The current study explores the effect of these variables on BNP decision statistics as well as the impact that changing cutoffs might have on the cost-effectiveness of diagnostic decisions that use BNP information.Results Significant differences in CHF rates were found on the basis of age (P < .001) and racial group (P = .020) but not sex (P = .424). BNP levels increased with increasing age (P < .001). To evaluate potential differences in the diagnostic utility of BNP levels as a function of demographic variables, separate receiver operating characteristic curves were performed. BNP was a stronger predictor in younger subjects than in older subjects and slightly weaker for female patients than for male patients (area under the curve = 0.918 and 0.870, respectively). An even smaller difference was noted between the white and black racial groups (area under the curve = 0.888 and 0.903, respectively). The differences in specificity as a function of age are larger than other differences in specificity or sensitivity. When logistic regression was used in a multivariate approach to combine the demographic variables with BNP information in the-prediction of CHF, only BNP contributed significantly to the prediction of acute CHF: When the model was expanded to include terms for the interaction of each of the demographic variables with logo BNP, a significant interaction was found for sex. Since the relative consequences of false-positives and false-negatives are unlikely to be equivalent, the BNP cut-points that would be selected based on the current data as a function of relative costs are presented. Sharply rising consequences are seen for BNP cut-points >100 pg/mL.Conclusions If one assumes that failing to treat cases of CHF is worse than treating negative cases, then relatively low BNP cut-points (eg, not >100 pg/mL) should be used in patients presenting to the Emergency Department with a chief complaint of dyspnea, regardless of age, sex, or ethnicity.