Role of N-Terminal Pro B-Type Natriuretic Peptide (NT-proBNP) for Diagnosing Underlying Cardiac and Extra-cardiac Diseases in Patients presenting with Acute Breathlessness in the Emergency Department

  • Nalini Bala Pandey Consultant Emergency Medicine, Department of Obstetrics and Gynaecology, Lok Nayak Hospital, Delhi, India.
  • Dina J Shah Director and Head of the Department, Department of Emergency Medicine, Fortis Hospital, Noida, Uttar Pradesh, India.
  • Parneesh Arora Additional Director, Department of Cardiology, Fortis Hospital, Noida, Uttar Pradesh, India.
  • AK Mathur Ex Scientist F, National Institute of Medical Statistics-Indian Council of Medical Research (ICMR), Delhi, India.
Keywords: Breathlessness, N-terminal pro-B-type Natriuretic Peptide, Heart Failure, Renal Failure, Sepsis


Background: Utility of NT-proBNP in patients presenting with acute breathlessness in the Emergency Department (ED) is high.

Aim and Objectives: To evaluate the role of NT-proBNP for early diagnosis of underlying cardiac and extra-cardiac diseases (renal, sepsis and respiratory failure) for patients presenting with acute breathlessness in the ED. The primary objective was correlation of NT-proBNP for diagnosing underlying diseases and the secondary objective was to establish its cutoff value to diagnose underlying diagnosis.

Methods: A prospective observational study was conducted on 241 patients with acute breathlessness in ED. They were categorised into two groups based on NT-proBNP values: Group 1 (high) and Group 2 (normal)
as per their age-related pre-determined cut-offs. Correlation in terms of validity of NT-proBNP against underlying diagnosis and its diagnostic values were assessed. To estimate the cut-off value of NT-proBNP for underlying diseases, Receiver Operating Characteristics (ROC) curve was plotted.

Results: For underlying cardiac diseases, the cutoff value of NT-proBNP in ROC curve was 931.5 pg/ml (Sensitivity: 92.6%, Specificity: 68.0%, AUCs: 0.85, p < 0.001) and for renal diseases, the cutoff value of NT-proBNP was 2280 pg/ml (Sensitivity: 92.2%, Specificity: 76.1%, AUCs: 0.94, p < 0.001).

Conclusion: This study established the role of NT-proBNP in indicating cardiac and renal involvement in patients presenting with acute breathlessness in the ED. In addition, normal NT-proBNP values rules out underlying cardiac and renal involvement. Also, higher NT-proBNP levels are indicative of multi-system involvement.

How to cite this article:
Pandey NB, Shah DJ, Arora P, Mathur AK. Role of N-Terminal Pro B-Type Natriuretic Peptide (NTproBNP)
for Diagnosing Underlying Cardiac and Extra-cardiac Diseases in Patients presenting with Acute Breathlessness in the Emergency Department. J Adv Res Med. 2021;8(4):1-11.



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