Independent and incremental prognostic value of multimarker testing in acute dyspnea: results from the ProBNP Investigation of Dyspnea in the Emergency Department (PRIDE) study.


Journal Article

Acute dyspnea is common in the emergency department (ED) and is associated with mortality. Biomarkers may help stratify risk in this setting.Among 577 dyspneic subjects we identified 5 candidate biomarkers with prognostic value: amino terminal B-type natriuretic peptide (NT-proBNP), C-reactive protein (CRP), the interleukin family member ST2, hemoglobin and blood urea nitrogen (BUN); these were assessed using both receiver operating characteristic curve and Cox proportional hazards analyses. Results were validated in a population of dyspneic patients from a distinct cohort.At 1 y follow up, 93 (16.1%) patients had died. Independent predictive ability was established in an age-adjusted Cox model containing all markers: NT-proBNP (HR=1.89); CRP (HR=1.95); ST2 (HR=7.17); hemoglobin (HR=1.68); BUN (HR=2.06) (all P<.05). Following categorical assessment based on number of abnormal markers, the 1-y risk of death increased in a monotonic fashion with mortality rates of 0%, 2.0%, 7.8%, 22.3%, 29.3%, and 57.6% respectively; similar results were seen in the validation set.Simultaneous assessment of pathophysiologically diverse markers in acute dyspnea provides powerful, independent and incremental prognostic information.

Full Text

Duke Authors

Cited Authors

  • Rehman, SU; Martinez-Rumayor, A; Mueller, T; Januzzi, JL

Published Date

  • June 2008

Published In

Volume / Issue

  • 392 / 1-2

Start / End Page

  • 41 - 45

PubMed ID

  • 18387360

Pubmed Central ID

  • 18387360

Electronic International Standard Serial Number (EISSN)

  • 1873-3492

International Standard Serial Number (ISSN)

  • 0009-8981

Digital Object Identifier (DOI)

  • 10.1016/j.cca.2008.03.002


  • eng