The predictive value of brain natriuretic peptide or N-terminal pro-brain natriuretic peptide for weaning outcome in mechanical ventilation patients: Evidence from SROC

Abstract

Objective: Mechanical ventilation is an important treatment for critically ill patients. Physicians generally perform a spontaneous breathing trial (SBT) to determine whether the patients can be weaned from mechanical ventilation, but almost 17% of the patients who pass the SBT still require respiratory support. Cardiac dysfunction is an important cause of weaning failure. The use of brain natriuretic peptide or N-terminal pro-BNP is a simple method to assess cardiac function. We performed a systematic review of investigations of brain natriuretic peptide or N-terminal pro-BNP as predictors of weaning from mechanical ventilation.

Data sources: PubMed (1950 to December 2020), Cochrane, and Embase (1974 to December 2020), and some Chinese databases for additional articles (China Biology Medicine (CBM), China Science and Technology Journal Database (CSTJ), and Wanfang Data and China National Knowledge Infrastructure (CNKI)).

Study selection: We systematically searched observation studies investigating the predictive value of brain natriuretic peptide or N-terminal pro-brain natriuretic peptide in weaning outcome of patients with mechanical ventilation.

Data extraction: Two independent reviewers extracted data. The differences are resolved through consultation.

Data synthesis: We included 18 articles with 1416 patients and extracted six index tests with pooled sensitivity and specificity for each index test. For the BNP change rate predicting weaning success, the pooled sensitivity was 89% (83%-94%) and the pooled specificity was 82% (72%-89%) with the highest pooled AUC of 0.9511.

Conclusions: The brain natriuretic peptide change rate is a reliable predictor of weaning outcome from mechanical ventilation.

Keywords: Brain natriuretic peptide; N-terminal pro-brain natriuretic peptide; ventilator weaning.

Figure 1.

Study flow diagram 2663 articles were retrieved. Finally, 18 articles were included according to pre-set inclusion criteria.

Figure 2.

QUADAS-2 results. The results of the QUADAS-2 evaluation are provided in different color. Deep color stands for low risk, middle color stands for unclear risk and stands for light color–high risk. Because most of the literature did not report whether consecutively included sample of patients, this part of the risk of bias is higher. At present, there is no clear weaning indicator, so this part of the risk of bias is also higher.

Figure 3.

Funnel plot.

Figure 4.

Forest plots sensitivity, specificity and summary receiver operating characteristic (SROC) with 95% confidence interval for BNP1, BNP2, ΔBNP, ΔBNP%, NT-pro BNP1, and NT-pro BNP2. It showed that the change of BNP levels before and after SBT was reported in five articles, the pooled sensitivity was 0.91, but the I² values was 58.5%. ΔBNP divided by baseline BNP had the highest pooled AUC of 0. 9511. And its I² values were 5.9% for specificity and 0% for sensitivity.