Introduction of an NT-proBNP assay to an acute admission unit--a 2-year audit.

Hdl Handle:
http://hdl.handle.net/10147/207786
Title:
Introduction of an NT-proBNP assay to an acute admission unit--a 2-year audit.
Authors:
Murtagh, Gillian; Canniffe, Carla; Mahgoub, Mohamed; Blake, Liam; McCarroll, Nuala; Crowley, Vivion; Bennett, Kathleen; Silke, Bernard
Affiliation:
Division of Internal Medicine, St. James' Hospital, Ireland.
Citation:
Eur J Intern Med. 2009 Jan;20(1):58-62. Epub 2008 Jul 16.
Journal:
European journal of internal medicine
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207786
DOI:
10.1016/j.ejim.2008.04.021
PubMed ID:
19237094
Abstract:
BACKGROUND: The differential diagnosis of dyspnoea is difficult due to the low predictive value of clinical and laboratory parameters. The elevated levels of NT-proBNP in congestive heart failure may improve diagnostic accuracy. We have evaluated the effect of the introduction of an NT-proBNP assay on hospital length of stay (LOS) and mortality. METHODS: There were 11,853 AMAU patient episodes in the 22 months study period (March 2005-Dec 2006). An NT-proBNP assay was requested in 657 (5.5%) of these. Comparison between categorical variables such as diagnosis, NT-proBNP testing, LOS, and in-hospital mortality was made using Chi-square tests. Literature review suggested that an NT-proBNP cut-off >or=5000 ng/L should predict acute in-patient mortality. Logistic regression analysis was used to examine the association between such an elevated NT-proBNP level and outcomes. RESULTS: Of the 396 patients with NT-proBNP <5000 ng/L, 8.1% died compared with 22.5% of the 178 patients dying with values >or=5000 ng/L (p<0.0001). An NT-proBNP >or=5000 ng/L was predictive of both LOS >or=9 days (odds ratios (OR) 1.54 (95% CI 1.06, 2.24: p=0.02) and LOS >or=14 days (OR=1.87 (95% CI 1.29, 2.71: p=0.0009). NT-proBNP requests increased over time, from 2.6% to 8.2% of all patients; the result fell in the diagnostic range for CHF in 60% of requests. CONCLUSION: The introduction of an NT-proBNP was reflected in an appropriate but rapidly increasing pattern of requests from clinicians. High NT-proBNP levels predicted in-hospital mortality and longer LOS in an acute medical population.
Language:
eng
MeSH:
Acute Disease; Adult; Aged; Aged, 80 and over; Diagnostic Tests, Routine/methods/*statistics & numerical data; Dyspnea/blood/diagnosis/mortality; Female; *Heart Failure/blood/diagnosis/mortality; Hospital Mortality; Humans; Inpatients/statistics & numerical data; Length of Stay/statistics & numerical data; Logistic Models; Male; *Medical Audit; Middle Aged; Natriuretic Peptide, Brain/*blood; Peptide Fragments/*blood
ISSN:
1879-0828 (Electronic); 0953-6205 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorMurtagh, Gillianen_GB
dc.contributor.authorCanniffe, Carlaen_GB
dc.contributor.authorMahgoub, Mohameden_GB
dc.contributor.authorBlake, Liamen_GB
dc.contributor.authorMcCarroll, Nualaen_GB
dc.contributor.authorCrowley, Vivionen_GB
dc.contributor.authorBennett, Kathleenen_GB
dc.contributor.authorSilke, Bernarden_GB
dc.date.accessioned2012-02-01T10:44:40Z-
dc.date.available2012-02-01T10:44:40Z-
dc.date.issued2012-02-01T10:44:40Z-
dc.identifier.citationEur J Intern Med. 2009 Jan;20(1):58-62. Epub 2008 Jul 16.en_GB
dc.identifier.issn1879-0828 (Electronic)en_GB
dc.identifier.issn0953-6205 (Linking)en_GB
dc.identifier.pmid19237094en_GB
dc.identifier.doi10.1016/j.ejim.2008.04.021en_GB
dc.identifier.urihttp://hdl.handle.net/10147/207786-
dc.description.abstractBACKGROUND: The differential diagnosis of dyspnoea is difficult due to the low predictive value of clinical and laboratory parameters. The elevated levels of NT-proBNP in congestive heart failure may improve diagnostic accuracy. We have evaluated the effect of the introduction of an NT-proBNP assay on hospital length of stay (LOS) and mortality. METHODS: There were 11,853 AMAU patient episodes in the 22 months study period (March 2005-Dec 2006). An NT-proBNP assay was requested in 657 (5.5%) of these. Comparison between categorical variables such as diagnosis, NT-proBNP testing, LOS, and in-hospital mortality was made using Chi-square tests. Literature review suggested that an NT-proBNP cut-off >or=5000 ng/L should predict acute in-patient mortality. Logistic regression analysis was used to examine the association between such an elevated NT-proBNP level and outcomes. RESULTS: Of the 396 patients with NT-proBNP <5000 ng/L, 8.1% died compared with 22.5% of the 178 patients dying with values >or=5000 ng/L (p<0.0001). An NT-proBNP >or=5000 ng/L was predictive of both LOS >or=9 days (odds ratios (OR) 1.54 (95% CI 1.06, 2.24: p=0.02) and LOS >or=14 days (OR=1.87 (95% CI 1.29, 2.71: p=0.0009). NT-proBNP requests increased over time, from 2.6% to 8.2% of all patients; the result fell in the diagnostic range for CHF in 60% of requests. CONCLUSION: The introduction of an NT-proBNP was reflected in an appropriate but rapidly increasing pattern of requests from clinicians. High NT-proBNP levels predicted in-hospital mortality and longer LOS in an acute medical population.en_GB
dc.language.isoengen_GB
dc.subject.meshAcute Diseaseen_GB
dc.subject.meshAdulten_GB
dc.subject.meshAgeden_GB
dc.subject.meshAged, 80 and overen_GB
dc.subject.meshDiagnostic Tests, Routine/methods/*statistics & numerical dataen_GB
dc.subject.meshDyspnea/blood/diagnosis/mortalityen_GB
dc.subject.meshFemaleen_GB
dc.subject.mesh*Heart Failure/blood/diagnosis/mortalityen_GB
dc.subject.meshHospital Mortalityen_GB
dc.subject.meshHumansen_GB
dc.subject.meshInpatients/statistics & numerical dataen_GB
dc.subject.meshLength of Stay/statistics & numerical dataen_GB
dc.subject.meshLogistic Modelsen_GB
dc.subject.meshMaleen_GB
dc.subject.mesh*Medical Auditen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshNatriuretic Peptide, Brain/*blooden_GB
dc.subject.meshPeptide Fragments/*blooden_GB
dc.titleIntroduction of an NT-proBNP assay to an acute admission unit--a 2-year audit.en_GB
dc.contributor.departmentDivision of Internal Medicine, St. James' Hospital, Ireland.en_GB
dc.identifier.journalEuropean journal of internal medicineen_GB
dc.description.provinceLeinster-

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