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

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    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.
    Issue Date
    2012-02-01T10:44:40Z
    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
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    Citation
    Eur J Intern Med. 2009 Jan;20(1):58-62. Epub 2008 Jul 16.
    Journal
    European journal of internal medicine
    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
    ISSN
    1879-0828 (Electronic)
    0953-6205 (Linking)
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.ejim.2008.04.021
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    St. James's Hospital

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