Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea
Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea
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DOI：
10.1056/nejmoa031681
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发表时间：
2004-02-12
影响因子：
158.5
通讯作者：
Perruchoud, AP
中科院分区：
文献类型：
--
作者：
Mueller, C;Scholer, A;Perruchoud, AP
背景：充血性心力衰竭患者的 B 型利钠肽水平高于其他原因引起的呼吸困难患者。方法：我们对 452 名因急性呼吸困难而到急诊科就诊的患者进行了一项前瞻性、随机、对照研究：225 名患者被随机分配接受使用快速床边检测来测量 B 型利钠肽水平的诊断策略，227 名患者以标准方式进行评估。出院时间和治疗总费用是主要终点。结果：两组之间的基线人口统计学和临床特征匹配良好。 B型利钠肽水平的使用减少了住院和重症监护的需要； B型利钠肽组中有75%的患者住院治疗，而对照组为85%（P=0.008）；B型利钠肽组有15%的患者需要重症监护，而对照组为24%（P=0.01）。 B型利钠肽组的中位出院时间为8.0天，对照组为11.0天（P=0.001）。 B 型利钠肽组的平均治疗总费用为 5,410 美元（95% 置信区间，4,516 美元至 6,304 美元），而对照组为 7,264 美元（95% 置信区间，6,301 美元至 8,227 美元）（P=0.006）。 30天死亡率分别为10%和12%（P=0.45）。结论：结合其他临床信息，在急诊科快速检测B型利钠肽改善了对急性呼吸困难患者的评估和治疗，从而缩短了出院时间和治疗总费用。
Background: B-type natriuretic peptide levels are higher in patients with congestive heart failure than in patients with dyspnea from other causes.Methods: We conducted a prospective, randomized, controlled study of 452 patients who presented to the emergency department with acute dyspnea: 225 patients were randomly assigned to a diagnostic strategy involving the measurement of B-type natriuretic peptide levels with the use of a rapid bedside assay, and 227 were assessed in a standard manner. The time to discharge and the total cost of treatment were the primary end points.Results: Base-line demographic and clinical characteristics were well matched between the two groups. The use of B-type natriuretic peptide levels reduced the need for hospitalization and intensive care; 75 percent of patients in the B-type natriuretic peptide group were hospitalized, as compared with 85 percent of patients in the control group (P=0.008), and 15 percent of those in the B-type natriuretic peptide group required intensive care, as compared with 24 percent of those in the control group (P=0.01). The median time to discharge was 8.0 days in the B-type natriuretic peptide group and 11.0 days in the control group (P=0.001). The mean total cost of treatment was $5,410 (95 percent confidence interval, $4,516 to $6,304) in the B-type natriuretic peptide group, as compared with $7,264 (95 percent confidence interval, $6,301 to $8,227) in the control group (P=0.006). The respective 30-day mortality rates were 10 percent and 12 percent (P=0.45).Conclusions: Used in conjunction with other clinical information, rapid measurement of B-type natriuretic peptide in the emergency department improved the evaluation and treatment of patients with acute dyspnea and thereby reduced the time to discharge and the total cost of treatment.