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Am J Emerg Med. 2006 Sep;24(5):603-7.

Evaluation of B-type natriuretic peptide to predict complicated pulmonary embolism in patients aged 65 years and older: brief report.

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  • 1Department of Emergency Medicine and Surgery, Centre Hospitalo-Universitaire (CHU) Pitié-Salpêtrière, Assistance-Publique Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie (Paris 6), 75013 Paris, France. patrick.ray@psl.ap-hop-paris.fr

Abstract

PURPOSES:

We evaluated the use of plasma B-type natriuretic peptide (BNP) levels for risk stratification in elderly patients with acute pulmonary embolism (PE).

BASIC PROCEDURES:

Bedside BNP assay was performed blindly at admission in consecutive patients older than 65 years with acute PE. A complicated PE was defined as any of the following: death, cardiopulmonary resuscitation, mechanical ventilation, use of vasopressors, thrombolysis, surgical embolectomy, or admission in intensive care unit.

MAIN FINDINGS:

Fifty-one patients (age, 79 +/- 9 years) were included. Thirteen patients had adverse events: 11 were admitted in the intensive care unit and 3 died. The median BNP level (95% confidence interval [CI]) was higher in the group of patients with complicated PE, 274 pg/mL (95% CI, 142-581 pg/mL) vs 78 pg/mL (95% CI, 33-230 pg/mL) (P < .05), respectively. The receiver operating characteristic curve showed that BNP significantly predicted a complicated PE with an area under the receiver operating characteristic curve of 0.72 (95% CI, 0.58-0.83) (P < .05). The best threshold value was 200 pg/mL with a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 0.69 (0.43-0.87), 0.63 (0.47-0.77), 0.39 (0.22-0.59), 0.86 (0.69-0.94), and 0.65 (0.51-0.77), respectively.

CONCLUSION:

Our study suggests that BNP is not a reliable marker of complicated PE in elderly patients.

PMID:
16938601
[PubMed - indexed for MEDLINE]
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