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Comparative Study
. 2011 Jun 22;12(1):83.
doi: 10.1186/1465-9921-12-83.

Diagnostic utility of C-reactive protein combined with brain natriuretic peptide in acute pulmonary edema: a cross sectional study

Kosaku Komiya  1 , Hiroshi Ishii, Shinji Teramoto, Osamu Takahashi, Nobuoki Eshima, Ou Yamaguchi, Noriyuki Ebi, Junji Murakami, Hidehiko Yamamoto, Jun-ichi Kadota
Affiliations
Comparative Study

Diagnostic utility of C-reactive protein combined with brain natriuretic peptide in acute pulmonary edema: a cross sectional study

Kosaku Komiya et al. Respir Res. .

Abstract

Introduction: Discriminating acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) from cardiogenic pulmonary edema (CPE) using the plasma level of brain natriuretic peptide (BNP) alone remains controversial. The aim of this study was to determine the diagnostic utility of combination measurements of BNP and C-reactive protein (CRP) in critically ill patients with pulmonary edema.

Methods: This was a cross-sectional study. BNP and CRP data from 147 patients who presented to the emergency department due to acute respiratory failure with bilateral pulmonary infiltrates were analyzed.

Results: There were 53 patients with ALI/ARDS, 71 with CPE, and 23 with mixed edema. Median BNP and CRP levels were 202 (interquartile range 95-439) pg/mL and 119 (62-165) mg/L in ALI/ARDS, and 691 (416-1,194) pg/mL (p < 0.001) and 8 (2-42) mg/L (p < 0.001) in CPE. BNP or CRP alone offered good discriminatory performance (C-statistics 0.831 and 0.887), but the combination offered greater one [C-statistics 0.931 (p < 0.001 versus BNP) (p = 0.030 versus CRP)]. In multiple logistic-regression, BNP and CRP were independent predictors for the diagnosis after adjusting for other variables.

Conclusions: Measurement of CRP is useful as well as that of BNP for distinguishing ALI/ARDS from CPE. Furthermore, a combination of BNP and CRP can provide higher accuracy for the diagnosis.

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Figures

Figure 1
Figure 1
Plasma concentrations of brain natriuretic peptide (BNP) A) and C-reactive protein (CRP) B) in patients with cardiogenic pulmonary edema (CPE) (n = 71), or acute lung injury/acute respiratory distress syndrome (ALI/ARDS) with (n = 53). The p values show between these subjects. The BNP levels in CPE patients were higher than those in ALI/ARDS patients (p < 0.001). The CRP levels in the ALI/ARDS patients were higher than those in the CPE patients (p < 0.001).
Figure 2
Figure 2
Receiver operating characteristics curve (AUC) analyses of brain natriuretic peptide (BNP), C-reactive protein (CRP), and BNP combined with CRP in discriminating cardiogenic pulmonary edema (CPE) from acute lung injury/acute respiratory distress syndrome (ALI/ARDS), excluding the mixed type of pulmonary edema. CRP levels were converted to the negative values, because lower CRP levels were expected to be more common in CPE patients. p < 0.001 compared BNP alone with combination BNP and CRP; p = 0.030 compared CRP alone with BNP and CRP.
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