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Usefulness of B-type natriuretic peptide in elderly patients with acute dyspnea

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Abstract

Objective

Differentiating cardiogenic pulmonary edema (CPE) from respiratory causes of dyspnea is particularly difficult in elderly patients. The aim of our study was to evaluate B-type natriuretic peptide (BNP) in patients older than 65 years presenting with acute dyspnea.

Design

Prospective study.

Setting

Medical emergency department of a 2000-bed urban teaching hospital.

Patients

Patients aged over 65 years presenting with acute dyspnea and a respiratory rate more than 25/min or a PaO2 below 70 mmHg, SpO2 less than 92%, PaCO2 higher than 45 mmHg with pH less than 7.35, were included. BNP levels, measured blind at admission were compared with the final diagnosis (CPE or no CPE) as defined by experts.

Intervention

None.

Measurements and results

Three hundred eight patients (mean age of 80 years) were enrolled in the study. The median BNP was 575 pg/ml [95% confidence interval (CI): 410–898] in the CPE group (n=141) versus 75 pg/ml (95% CI: 59–98) in the no CPE group (n=167) (p<0.001). The best threshold value of BNP was 250 pg/ml, with a sensitivity and specificity for CPE of 0.78 (95% CI: 0.71–0.84) and 0.90 (95% CI: 0.84–0.93), respectively. The area under the ROC curve was 0.874±0.081 (p<0.001). The accuracy of BNP-assisted diagnosis was higher than that of the emergency physician (0.84 versus 0.77, p<0.05).

Conclusion

Analysis of BNP is useful in elderly patients with acute dyspnea, but the threshold value is higher than that previously determined.

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Acknowledgements

The authors would like to thank the physicians and nursing staff working in the emergency department and all the physicians of the EPIDASA study group: Dr M.-H. Becquemin, Dr J. Boddaert, Dr R. Isnard and Dr A. Teixeira, for their cooperation and support. We also thank Dr D.J. Baker (Department of Anesthesiology, CHU Necker-Enfants Malades, Paris, France) for reviewing the manuscript.

This study was supported solely from departmental sources. The test and kits for BNP assay were provided free of charge by Biosite USA/BMD France.

Author information

Authors and Affiliations

  1. Department of Emergency Medicine and Surgery, Centre Hospitalo-Universitaire (CHU) Pitié-Salpêtrière Hospital, Assistance-Publique Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie, 47 boulevard de l’Hôpital, 75013, Paris, France

    Patrick Ray & Bruno Riou

  2. Laboratory of Emergency Biology, Centre Hospitalo-Universitaire (CHU) Pitié-Salpêtrière Hospital, Assistance-Publique Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie, 47 boulevard de l’Hôpital, 75013, Paris, France

    Martine Arthaud

  3. Department of Pneumology, Centre Hospitalo-Universitaire (CHU) Pitié-Salpêtrière Hospital, Assistance-Publique Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie, 47 boulevard de l’Hôpital, 75013, Paris, France

    Yannick Lefort & Sophie Birolleau

  4. Department of Radiology, Centre Hospitalo-Universitaire (CHU) Pitié-Salpêtrière Hospital, Assistance-Publique Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie, 47 Boulevard de l’Hôpital, 75013, Paris, France

    Catherine Beigelman

Authors
  1. Patrick Ray
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  2. Martine Arthaud
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  3. Yannick Lefort
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  4. Sophie Birolleau
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the EPIDASA Study Group

Corresponding author

Correspondence to Patrick Ray.

Additional information

Presented, in part, at the 30th annual congress of the Société de Réanimation de Langue Française, Paris, January 2002 (abstract no. SP 94).

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Ray, P., Arthaud, M., Lefort, Y. et al. Usefulness of B-type natriuretic peptide in elderly patients with acute dyspnea. Intensive Care Med 30, 2230–2236 (2004). https://doi.org/10.1007/s00134-004-2469-0

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  • DOI: https://doi.org/10.1007/s00134-004-2469-0

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