MR-proANP, MR-proADM, and PCT in Patients Presenting with Acute Dyspnea in a Medical Emergency Unit.

Abstract

The evaluation of the role of novel biomarkers in the management of cardiac and pulmonary conditions has received particular attention in recent years. A further particular perspective is the use of biomarker panels in the evaluation of patients presenting with acute dyspnea. We prospectively evaluated three biomarkers (MR-proANP, PCT, and MR-proADM) in consecutive patients presenting with acute dyspnea in a medical emergency unit during a 4-week period. Patients received a final diagnosis. Biomarkers were tested for their potential to predict diagnoses and survival. No intervention was done. Overall, n=172 patients were included. Of these, 32.6% had acute heart failure, 16.9% pneumonia, and 5.8% died. MR-proANP was the highest in patients with acute heart failure and lung embolism. Dyspnea scores and levels of MR-pro-ANP correlated positively. MR-proANP achieved an AUC of 0.83 for the diagnosis of acute heart failure. Using a cut-off of 120pmol/l, sensitivity was 91.1% and specificity 50%. PPV was 46.8% and NPV 92.1%. In patients with MR-proANP >300pmol/l, PPV raised to 67.3%. MR-proADM had an AUC of 0.84 for the prediction of death. PPV was 16% and NPV 98.4%. The AUC of PCT was 0.74 for the diagnosis of pneumonia. Using a cut-off of 0.25ng/ml, PCT had a sensitivity of 44.8% and a specificity of 85.3%. PPV was 38.2 and NPV 88.4%. Using a lower cut-off of <0.1ng/ml, NPV reached 92.9%. A panel of three biomarkers (MR-proANP, PCT, and MR-proADM) in patients presenting to the emergency unit with acute dyspnea provides information about the probability of acute heart failure, nonsurvival, and pneumonia. These biomarkers achieve low to moderate positive predictive values (PPV) and high negative predictive values (NPV).