What is the value of B-type natriuretic peptide testing for diagnosis, prognosis or monitoring of critically ill adult patients in intensive care?
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Robert H. Christenson
Abstract
Background: B-natriuretic peptide (BNP) and aminoterminal proBNP (NT-proBNP) are clinically useful for the diagnosis of decompensated heart failure and for prognosis in heart failure and acute coronary syndromes. Clinical use of these biomarkers in critically ill patients being treated in intensive care is not well established.
Methods: This is a narrative review of evidence identified searching MEDLINE with the strategy [(BNP OR NT-proBNP) AND (critical illness AND intensive care)]. Seven primary reports and two narrative reviews were retrieved. For completeness, literature from each of the following searches was reviewed: [(BNP OR NT-proBNP) AND (critical illness)] and [(BNP OR NT-proBNP) AND (intensive care)].
Results: Primary literature used BNP and NT-proBNP for diagnosis, prognosis and monitoring. For diagnosis of acute lung injury in unselected intensive care patients and for diagnosis of heart failure in trauma patients, the biomarkers had low sensitivity and are of modest use. BNP and NT-proBNP were found to have a significant ability to prognosticate adverse outcomes in critically ill patients. A single paper examined the use of BNP as a non-invasive replacement for pulmonary capillary wedge pressure, finding little value. The impact of renal insufficiency on the markers was noted as a confounder in most studies. In the secondary searches, some preliminary data suggested a possible role for the natriuretic peptides in exclusion of a cardiac cause for certain conditions among intensive care unit (ICU) patients. However, the general findings were that the performance of BNP and NT-proBNP is unimpressive among ICU patients.
Conclusions: Currently, utilization of BNP and NT-proBNP does not appear to provide much useful information or have a substantial role in the care of critically ill patients in intensive care.
Clin Chem Lab Med 2008;46:1524–32.
©2008 by Walter de Gruyter Berlin New York
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Articles in the same Issue
- Editorial
- Biochemical markers in clinical cardiology: perspectives from present to future. 1st IFCC-Ortho Clinical Diagnostics Conference on Clinical Diagnosis and the Clinical Laboratory
- Highlight: Cardiovascular Biomarkers
- Reviews
- The clinical impact of the universal diagnosis of myocardial infarction
- Troponin revisited 2008: assay performance
- Standardization of troponin I measurements: an update
- Biochemistry of B-type natriuretic peptide – where are we now?
- Clinical relevance of non-cardiac determinants of natriuretic peptide levels
- What is the value of B-type natriuretic peptide testing for diagnosis, prognosis or monitoring of critically ill adult patients in intensive care?
- Natriuretic peptide testing in primary care patients
- Natriuretic peptide testing in emergency settings
- Minireviews
- Oxidative stress, free radicals and bone remodeling
- Plasma homocysteine and vascular disease in elderly patients with mental illness
- Opinion Papers
- Fate of abstracts presented at the 2002 IFCC meeting
- Transition from congress abstract to full paper: the case of a national Argentinean congress in clinical laboratory
- Genetics and Molecular Diagnostics
- Association of endothelin-1 gene polymorphisms with variant angina in Korean patients
- Single nucleotide polymorphisms in ABCG5 and ABCG8 genes in Chilean subjects with polygenic hypercholesterolemia and controls
- Paternal exclusion: allele sharing in microsatellite testing
- General Clinical Chemistry
- Rapid sample preparation and simultaneous quantitation of prostaglandins and lipoxygenase derived fatty acid metabolites by liquid chromatography-mass spectrometry from small sample volumes
- Plasma bilirubin correlations in non-obstructive cholestasis after partial hepatectomy
- Aggregation of lipoprotein and inflammatory parameters in families with a history of premature myocardial infarction: the Tallinn Myocardial Infarction Study
- Significant elevation of a Th2 cytokine, interleukin-10, in pelvic inflammatory disease
- Hemoglobin A1c determination in the A1C-Derived Average Glucose (ADAG) study
- The effect of the mode of delivery on maternal-neonatal interleukin-6, biogenic amine and their precursor amino acid concentrations
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- Validation and Outcome Studies
- Benefits of the iQ200 automated urine microscopy analyser in routine urinalysis
- Electrochemical detection of blood alcohol concentration using a disposable biosensor based on screen-printed electrode modified with Nafion and gold nanoparticles
- About the z-multiplier in total error calculations
- Letters to the Editor
- A hypothyroid patient with increased free thyroid hormones
- Evaluation of blood collection tubes specific for homocysteine measurement
- Influence of assay-dependent variability of serum insulin levels on insulin sensitivity indices
- Frequency and type of preanalytical errors in a laboratory medicine department in India
- Sample dilution causes a positive bias on C-reactive protein using VITROS reagents, diluents and instruments – clinical implications?
