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Published on: January 27, 2023
Diagnostic Accuracy of Urinary N Terminal pro-B Type Natriuretic Peptides for Hemodynamically Significant-Patent
Srirupa Hari Gopal1, Ganga Gokulakrishnan1, Madhulika Kulkarni1
1Section of Neonatology, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA.
Insights
Urinary N-terminal pro-B-type natriuretic peptides (NT-proBNP) show modest accuracy for diagnosing hemodynamically significant-patent ductus arteriosus (hs-PDA) in preterm infants. Local validation is crucial before widespread clinical use.
Area of Science:
- Neonatal Medicine
- Diagnostic Accuracy Studies
- Biomarker Research
Background:
- Echocardiography is the gold standard for diagnosing hemodynamically significant-patent ductus arteriosus (hs-PDA) but requires specialized personnel and equipment.
- Urinary biomarkers offer a potential adjunct diagnostic tool for hs-PDA.
Purpose of the Study:
- To systematically review the diagnostic accuracy of urinary N-terminal pro-B-type natriuretic peptides (NT-proBNP) for hs-PDA in preterm neonates.
Main Methods:
- Systematic review including studies evaluating urinary NT-proBNP and NT-proBNP/creatinine ratio in preterm neonates.
- Echocardiography served as the reference standard for hs-PDA diagnosis.
- Quality Assessment of Diagnostic-Accuracy Studies (QUADAS-2) and Grading of Recommendations Assessment, Development and Evaluation (GRADE) were used.
Main Results:
- Low quality of evidence indicates modest sensitivity and specificity for urinary NT-proBNP in diagnosing hs-PDA.
- Diagnostic accuracy varied depending on the specific assay used and patient characteristics.
Conclusions:
- Urinary NT-proBNP assays require local validation for specific preterm infant populations.
- Further research is necessary to support the clinical utility of urinary NT-proBNP for hs-PDA diagnosis.
Background:
Echocardiography is the gold standard for the diagnosis hemodynamically significant-patent ductus arteriosus (hs-PDA). It requires trained personnel and is not readily available. Urinary biomarkers can be used as an adjunct.
Objective:
The objective of this study was to systematically review the diagnostic accuracy of urinary N terminal pro-B type natriuretic peptides (NT-proBNP) for hs-PDA in preterm neonates.
Methods:
We included studies that evaluated urinary NT-proBNP and urinary NT-proBNP/creatinine ratio (index tests) in preterm neonates with hs-PDA (participants) in comparison with echocardiogram (reference standard). Methodological quality and certainty of evidence were assessed using Quality Assessment of Diagnostic-Accuracy Studies (QUADAS-2) and Grading of Recommendations Assessment, Development and Evaluation (GRADE), respectively.
Results:
Low quality of evidence suggests that urinary NT-proBNP has modest sensitivity and specificity for the diagnosis of a hs-PDA, with variation in accuracy based on assay and patient characteristics.
Conclusion:
Urinary NT-proBNP assays must be locally validated for specific patient populations and further studies to support its use must be performed.
