Shagufta Yousaf, Asif Nadeem, Ghulam Murtaza Shaikh, Hamid Jamal Siddiqui, Muhammad Yasir Rafiq, Abeera Ahmad.
Clinical utility of plasma nt-probnp in diagnosing acute dyspnea.
Pak J Pathol Jan ;31(2):46-9.

Objectives: To evaluate the clinical utility of NT-ProBNP assay in patients, admitted in Intensive care unit, with acute dyspnea. Material & Methods: This Observational cross-sectional study was conducted at Combined Military Hospital Malir Cantt Karachi From Jan 2019 to Dec 2019. In this study, total 632 patients were selected with purposive non-probability sampling who were admitted in the intensive care unit (ICU) with acute dyspnea. ECGs, CXRs, Echos and plasma NT-ProBNP levels were analyzed along with other lab tests. Using the discharge diagnosis as the gold standard, clinical findings, provisional diagnoses and NT-ProBNP levels were cross tabulated with the final diagnosis. The Chi-square test for categorical data and student`s t test for numerical data were applied and p value < 0.05 for significance level was applied to compare cardiac vs non-cardiac dyspnea. Further comparative analysis between the age groups was done by one-way ANOVA test. Results:Of the total 632 cases studied of acute dyspnea, NT-proBNP levels were acutely raised in 73% of cases to a mean level of 19760pg/ml which were alarming numbers. These patients were categorized and treated as `cardiac dyspnea with heart failure`, as compared to the remaining 27% cases in which the NT-proBNP levels were either normal or marginally elevated with a mean value of 119 pg/ml. They were diagnosed and treated as `non-cardiac dyspnea without heart failure` (p=0.001). The diagnostic accuracy of NT-proBNP at a cutoff of 400 pg/ml for age <45 years was 100% sensitivity but 34% specificity. An optimal strategy to identify acute Heart Failure (HF) was to use age-related cut-points, 800 pg/ml for ages> 45 years having 98% sensitivity and 87% specificity. Conclusions: NT-proBNP is a rapid and reliable cardiac biomarker which can revolutionize the clinician`s approach towards diagnosing and treating the underlying cause of acute dyspnea. In addition, its serial essays can predict the prognosis and outcome of admitted patients.

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