Diagnostic Role Of NT-proBNP And Uric Acid In Detecting Acute Pulmonary Embolism From Congestive Heart Failure In Dyspneic Patients

Backgrounds:Acute pulmonary embolism is a common severe acute disease with both respiratory and circulation disorders. Despite advances in diagnosis and treatment over recent years, its early mortality rate is still high. As the lack of typical clinical feature, the misdiagnosed rate of acute pulmonary embolism is very high. Acute dyspnea is one of the most common presentation of acute pulmonary embolism, as well as the most common complaint in emergency room, as a result, acute pulmonary embolism patients complaining acute dyspnea are often misdiagnosed as other diseases. Congestive heart failure is a very common disorder with the most common complaint of acute dyspnea. As acute pulmonary embolism and congestive heart failure are both diseases with less typical features, acute pulmonary embolism patients complaining acute dyspnea are often misdiagnosed as congestive heart failure. In this study, we aim to explore the role of NT-proBNP and Uric Acid (UA) in the differential diagnosis of acute pulmonary embolism and congestive heart failure in acute dyspneic patients, by comparing the difference of the levels of the two biomarkers.Methods:Consecutive patients complaining of acute dyspnea were prospectively studied between June 2010 and May 2015. The included patients were divided into two groups, acute pulmonary embolism group and congestive heart failure group according to the diagnosis. The inclusion criteria are as follows,1. The included patients should all complain of acute dyspnea.2. Patients should be diagnosed as acute pulmonary embolism or congestive heart failure. The exclusion criteria are as follows,1. younger than 18 years old,2. with liver or kidney dysfunction,3. with pregnancy,4. with gout,5. with a prognosis of dying in 48 hours. Once the patient was enrolled in this study, blood samples were collected for measurement. Statistical analysis was performed by SPSS 17.0 (SPSS, IBM SPSS, USA). P<0.05 was considered statistically significant. The data were described using mean±D for continuous variables and number (%) for categorical variables. Statistical differences between the two groups were analysed using the t test, Kruskal-Wallis test, Mann-Whitney U test, or x2 test for normally distributed variables as appropriate.Results:During the period of June 2010 to May 2015,288 patients attending our emergency department with symptoms of acute dyspnoea were consecutively enrolled. These patients were divided into two groups according to the diagnosis, APE group (n=107) and CHF group (n=181). Patients in APE group had significantly lower median levels of NT-proBNP and UA compared to subjects in CHF group (2421.7 pg/ml vs.6964.3 pg/ml, PO.01, and 492.1 umol/L vs.340.6 umol/L, PO.01, respectively). The areas under the ROC curve (AUC) for NT-proBNP and UA were 0.883 and 0.780, respectively. When an NT-proBNP level of 1889 pg/ml was used as the cutoff value, the specificity was 94.5%. For a uric acid level of 278.5 umol/L, the specificity was 93.9%. The combination of the two biomarkers showed a specificity of 99.4%.Conclusion:NT-proBNP and uric acid can be used in detecting acute pulmonary embolism from congestive heart failure in dyspneic patients, to decrease the misdiagnosed rate of acute pulmonary embolism and improve the prognosis of acute pulmonary embolism patients.