Calzavacca P, Licari E, Tee A, Bellomo R. Point-of-care testing during medical emergency team activations: a pilot study.
Resuscitation 2012;
83:1119-23. [PMID:
22353639 DOI:
10.1016/j.resuscitation.2012.02.012]
[Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 01/02/2012] [Accepted: 02/10/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE
To estimate the prognostic value of point-of-care measurement of biomarkers related to dyspnea in patients receiving a medical emergency team (MET) review.
DESIGN
Prospective observational study.
SETTING
University affiliated hospital.
PATIENTS
Cohort of 95 patients receiving MET review over a six month period.
METHODS
We used a commercial multi-biomarker panel for shortness-of-breath (SOB panel) (Biosite Triage Profiler, Biosite Incorporated®), 9975 Summers Ridge Road, San Diego, CA 92121, USA) including Brain natriuretic peptide (BNP), D-dimer, myoglobin (Myo), creatine kinase MB isoenzyme (CK-MB) and troponin I (Tn-I). We recorded information about demographics, MET review triggers, and MET procedures and patient outcome.
RESULTS
Mean age was 70.5 (±15) years, 38 (41%) patients had a history of chronic heart failure (CHF) and 67 (70%) chronic kidney disease (CKD). At MET activation, 42 (44%) patients were dyspneic. The multi-biomarker panel was positive for at least one marker in 48 (51%) cases. BNP and D-dimer had a sensitivity of 0.79 and 0.93 for ICU admission with a negative predictive value (NPV) of 0.89 and 0.92 respectively. Thirty-five (37%) patients died. BNP was positive in 85% of such cases with sensitivity and NPV of 0.86 and 0.82, respectively. D-dimer was positive in 77% of non-survivors with a sensitivity and NPV of 0.94 and 0.88, respectively. BNP (area under the curve of receiver operating characteristic curve--AUC-ROC: 0.638) and D-dimer (AUC-ROC: 0.574) achieved poor discrimination of subsequent death. Similar findings applied to ICU admission. The combination of normal BNP and D-dimer levels completely ruled out ICU admission or death. The cardiac part of the panel was not useful in predicting ICU admission or mortality.
CONCLUSIONS
Although, BNP and D-dimer are poor discriminants of ICU admission and hospital mortality, normal BNP and D-dimer levels practically exclude subsequent need for ICU admission and hospital mortality.
Collapse