Predictive Value Of Brain Natriuretic Peptide For Endotracheal Tube Extubation In Invasive Mechanically Ventilated Patients During Spontaneous Breathing Trial:A Meta-analysis

Background:To assess the predictive value of brain natriuretic peptide for endotracheal tube extubation in invasive mechanically ventilated patients during spontaneous breathing trial.Methods:Databases were searched including PubMed,Embase,Medline,Ovid,Cochrane Central Register of Controlled Trails,the Information Sciences Institute Web of Science as well as Wanfang database,from inception to October 31,2019,without the limitation of language and date.Two investigators independently evaluated the inclusion,assessed the study quality and abstracted the data.Sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic ratio and area under the curve were analyzed by Review 5.3 and Meta-Disc.Results:A total of 1266 patients from 18 trials were recruited.For the BNP1 predicting weaning success,the value of weighted sensitivity was 81%(95%CI 0.78-0.84),specificity was 83%(95%CI 0.78-0.87),positive likelihood ratio was 4.3(95%CI 3-6.16),negative likelihood ratio was 0.25(95%CI 0.19-0.32),diagnostic odds ratio was 20.23(95% CI 13.53-30.25)and AUC was 0.888.For the BNP2 predicting weaning success,the value of weighted sensitivity was 74%(95%CI 0.68-0.80),specificity was 82%(95%CI 0.71-0.90),positive likelihood ratio was 3.72(95%CI 1.75-7.92),negative likelihood ratio was 0.27(95%CI 0.09-0.88),diagnostic odds ratio was 15.34(95% CI3.77-62.47)and AUC was 0.8895.For the ?BNP predicting weaning success,the value of weighted sensitivity was 90%(95%CI 0.86-0.93),specificity was 77%(95%CI0.68-0.85),positive likelihood ratio was 4.59(95%CI 2.03-10.38),negative likelihood ratio was 0.13(95%CI 0.09-0.18),diagnostic odds ratio was 46.34(95% CI 22.30-96.3)and AUC was 0.95.For the BNP change rate predicting weaning success,the value of weighted sensitivity was 86%(95%CI 0.78-0.91),specificity was 81%(95%CI 0.69-0.89),positive likelihood ratio was 3.81(95%CI 2.27-6.4),negative likelihood ratio was 0.18(95%CI 0.12-0.28),diagnostic odds ratio was 22.76(95% CI 9.87-52.49)and AUC was0.916.Conclusion:Plasma BNP elevated the predictive value for extubation in Mechanical Ventilation.More large-sample,multi-center,high-quality prospective studies need be performed in future.