Some heterogeneity factors affecting the B-type natriuretic peptides outcome: a meta-analysis
-
Paolo Mastandrea
Abstract
Background: Cardiac B-type natriuretic peptides (NPs) are products of a complex neuro-hormonal equilibrium also involving heart and kidneys; they should be carefully handled as heart failure (HF) markers. Meta-analysis of variance (ANOVA) could extrapolate heterogeneity factors (HeFs) in an attempt to reliably evaluate the outcome.
Methods: A total of 98 samples from 67 studies were considered – 52 samples from 41 studies evaluating brain natriuretic peptide (BNP), 46 from 24 evaluating N-terminal pro-brain natriuretic peptide (NT-proBNP). Case-control apparently unbiased studies linking NP values to a specific degree of HF clinical severity (HFd), and considering marker sensitivity and specificity, were selected. As an outcome measurement, the natural logarithm of [(true positives/false negatives)/(false positives/true negatives)] was considered. On data negative to the distribution normality and to the publication bias tests, the random-effect heterogeneity test was applied; heterogeneous data – adjusted for the candidate HeFs – were tested using the one-way meta-ANOVA. Afterwards, contrast tests among level means were carried out on the HeFs significant to the one-way meta-ANOVA and not significant to the interaction two-way meta-ANOVA tests. A sensitivity analysis was carried out on the data without the outlier results.
Results and conclusions: Reference method (RM), disease prevalence (DP) and HFd resulted in significant BNP HeFs, RM and DP being responsible for, respectively, reference and spectrum biases. No significant NT-proBNP HeFs were found.
Clin Chem Lab Med 2008;46:1687–95.
©2008 by Walter de Gruyter Berlin New York
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- Subject Index
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