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
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
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DOI：
10.3325/cmj.2009.50.133
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发表时间：
2009-04-01
影响因子：
1.9
通讯作者：
Grmec, Stefek
中科院分区：
文献类型：
--
作者：
Klemen, Petra;Golub, Mirjam;Grmec, Stefek
目的探讨定量碳纳米管(QC)、N末端脑利钠肽原(NT-proBNP)和临床评估相结合在心力衰竭(HF)相关性急性呼吸困难和肺源性急性呼吸困难的诊断价值。比较两组急性呼吸困难患者：心力衰竭相关性急性呼吸困难组(238例)和肺源性急性呼吸困难(哮喘/COPD)组(203例)。主要结果是结合QC、NT-proBNP和临床评估与单独使用NT-proBNP或NT-proBNP结合临床评估，利用受试者工作特征曲线下面积(AUROC)区分院前急诊中心力衰竭相关的急性呼吸困难和肺相关的急性呼吸困难(哮喘/COPD)。次要结果终点是确定最终诊断急性呼吸困难(由急性心力衰竭或肺部疾病引起)的独立预测因素，以及在既往有心力衰竭病史的患者亚组和既往有肺部疾病病史的患者亚组中测定NT-proBNP水平和二氧化碳充盈率。结果在院前急诊中区分急性呼吸困难的心脏和呼吸系统原因方面，NT-proBNP结合PetCO2和临床评估(AUROC，0.97；95%可信区间[95%CI](0.90~0.99)优于NT-ProBNP结合临床评估(AUROC，0.94；95%CI，0.88~0.96；P=0.006)或单独使用NT-ProBNP(AUROC，0.9；95%CI，0.85~0.94；P=0.005)。NT-proBNP>；=2000 pg/mL和PetCO2的值
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