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Meta-Analysis
. 2015 Dec;3(12):977-89.
doi: 10.1016/j.jchf.2015.07.014.

Amino-Terminal Pro-B-Type Natriuretic Peptide for Diagnosis and Prognosis in Patients With Renal Dysfunction: A Systematic Review and Meta-Analysis

Jennifer A Schaub  1 , Steven G Coca  2 , Dennis G Moledina  1 , Mark Gentry  3 , Jeffrey M Testani  1 , Chirag R Parikh  4
Affiliations
Meta-Analysis

Amino-Terminal Pro-B-Type Natriuretic Peptide for Diagnosis and Prognosis in Patients With Renal Dysfunction: A Systematic Review and Meta-Analysis

Jennifer A Schaub et al. JACC Heart Fail. 2015 Dec.

Abstract

Objectives: This study sought to determine if amino-terminal pro-B-type natriuretic peptide (NT-proBNP) has different diagnostic and prognostic utility in patients with renal dysfunction.

Background: Patients with renal dysfunction have higher NT-proBNP, which may complicate interpretation for diagnosis of acute decompensated heart failure (ADHF) or prognosis.

Methods: We searched MEDLINE and EMBASE through August 2014 for studies with a subgroup analysis by renal function of the diagnostic or prognostic ability of NT-proBNP.

Results: For diagnosis, 9 studies were included with 4,287 patients and 1,325 ADHF events. Patients were mostly divided into subgroups with and without renal dysfunction by an estimated glomerular filtration rate of 60 ml/min/1.73 m(2). In patients with renal dysfunction, the area under the curve (AUC) for NT-proBNP ranged from 0.66 to 0.89 with a median cutpoint of 1,980 pg/ml, while the AUC ranged from 0.72 to 0.95 with a cutpoint of 450 pg/ml in patients with preserved renal function. For prognosis, 30 studies with 32,203 patients were included, and mortality in patients with renal dysfunction (25.4%) was twice that of patients with preserved renal function (12.2%). The unadjusted pooled risk ratio for NT-proBNP and mortality was 3.01 (95% confidence interval [CI]: 2.53 to 3.58) in patients with preserved renal function and was similar in patients with renal dysfunction (3.25; 95% CI: 2.45 to 4.30). Upon meta-regression, heterogeneity was partially explained if patients with heart failure or coronary artery disease were enrolled.

Conclusions: NT-proBNP retains utility for diagnosis of ADHF in patients with renal dysfunction with higher cutpoints. Elevated NT-proBNP confers a worse prognosis regardless of renal function.

Keywords: amino-terminal pro-B-type natriuretic peptide; diagnosis; prognosis; renal dysfunction.

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Figures

Figure 1A
Figure 1A. Forest Plots for Sensitivity and Specificity for Diagnosis of ADHF
Figure 1B
Figure 1B. Comparison of Summary ROC for eGFR>60 and <60
Data points represent the overall sensitivity and 1-specificity from an individual study. Summary ROC curve was generated by the Moses method.
Figure 2A
Figure 2A. Crude Estimates of Mortality in Patients with Preserved Renal Function
CAD=coronary artery disease, HF=heart failure, PAD=peripheral artery disease
Figure 2B
Figure 2B. Crude Estimates of Mortality in Patients with Diminished Renal Function
CAD=coronary artery disease, HF=heart failure, PAD=peripheral artery disease
Figure 3A
Figure 3A. Adjusted Estimates of Mortality in Patients with Preserved Renal Function
Figure 3B
Figure 3B. Adjusted Estimates of Mortality in Patients with Diminished Renal Function
See this image and copyright information in PMC

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