Evaluation of mid-regional pro-atrial natriuretic peptide, procalcitonin, and mid-regional pro-adrenomedullin for the diagnosis and risk stratification of dyspneic ED patients☆☆☆★★★
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Fig. 1
Flow diagram for diagnostic evaluation.
Fig. 2
ROC curve for MR-proADM and mortality.
Abstract
Objective
The aim of this study was to evaluate the diagnostic and the prognostic value of a laboratory panel consisting of mid-regional pro-atrial natriuretic peptide (MR-proANP), procalcitonin (PCT), and mid-regional pro-adrenomedullin (MR-proADM) for patients presenting to the emergency department (ED) with acute dyspnea.
Methods
We prospectively enrolled ED patients who presented with a chief complaint of dyspnea and who had an uncertain diagnosis after physician evaluation. Final primary diagnosis of the cause of shortness of breath was confirmed through additional testing per physician discretion. We recorded inpatient admission and 30-day mortality rates.
Results
One hundred fifty-four patients were enrolled in the study. Congestive heart failure exacerbation was the final primary diagnosis in 42.2% of patients, while infectious etiology was diagnosed in 33.1% of patients. For the diagnosis of congestive heart failure exacerbation, MR-proANP had a sensitivity of 92.7% and specificity of 36.8%, with a negative likelihood ratio (LR−) of 0.16 and a positive likelihood ratio (LR+) of 1.44 (cut-off value: 120 pmol/L). For the diagnosis of an infectious etiology, PCT had a 96.5% specificity and 48.8% sensitivity (LR−: 0.58, LR+: 13.8, cutoff value: 0.25 ng/mL). As a prognostic indicator, MR-proADM demonstrated similar values: odds ratio for 30-day mortality was 8.5 (95% CI, 2.5-28.5, cutoff value: 1.5 nmol/L) and the area under the receiver operating characteristic curve in predicting mortality was 0.81 (95% CI, 0.71-0.91).
Conclusion
The good negative LR− of MR-proANP and the good positive LR+ of PCT may suggest a role for these markers in the early diagnosis of ED patients with dyspnea. Furthermore, MR-proADM may assist in risk stratification and prognosis in these patients..
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☆Prior Publication: This article is an original work and it has not been published or submitted for publication elsewhere, in whole or in part, before submission to Academic Journal of Emergency Medicine. Abstract of the article has been selected for oral presentation at the 2011 ACEP Research Forum in San Francisco, CA.
☆☆Conflict of interest: BRAHMS supplied the reagents needed for the new marker measurements.We declared that we have no commercial, financial, and other relationships in any way related to the subject of this article all that might create any potential conflict of interest.
★Funding and support: Nothing to declare.
★★Statistical Analysis: Statistical analysis was performed by Cengiz Han Acikel, one of the faculty in Department of Public Health, Gulhane Military Medical Academy.
