Research
Diagnostic utility of C-reactive Protein combined with brain natriuretic peptide in acute pulmonary edema: a cross sectional study
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* Corresponding author: Hiroshi Ishii hishii@oita-u.ac.jp
1 Department of Internal Medicine 2, Oita University Faculty of Medicine, 1-1 Idaigaoka, Yufu (879-5593), Japan
2 Department of Respiratory Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Hitachinaka Education and Research Center, 20-1 Ishikawa, Hitachinaka (317-0077), Japan
3 Center for Clinical Epidemiology, St. Luke's Life Science Institute, 10-1 Akashi-machi, Chuo (104-0044), Japan
4 Department of Biostatistics, Oita University Faculty of Medicine, 1-1 Idaigaoka, Yufu (879-5593), Japan
5 Departments of Respiratory Medicine, Aso Iizuka Hospital, 3-83 Yoshio-machi, Iizuka (820-0018), Japan
6 Department of Radiology, Aso Iizuka Hospital, 3-83 Yoshio-machi, Iizuka (820-0018), Japan
Respiratory Research 2011, 12:83 doi:10.1186/1465-9921-12-83
Published: 22 June 2011Abstract
Introduction Discriminating acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) from cardiogenic pulmonary edema (CPE) using the plasma level of brain natriuretic peptide (BNP) alone remains controversial. The aim of this study was to determine the diagnostic utility of combination measurements of BNP and C-reactive protein (CRP) in critically ill patients with pulmonary edema.
Methods
This was a cross-sectional study. BNP and CRP data from 147 patients who presented to the emergency department due to acute respiratory failure with bilateral pulmonary infiltrates were analyzed.
Results
There were 53 patients with ALI/ARDS, 71 with CPE, and 23 with mixed edema. Median BNP and CRP levels were 202 (interquartile range 95-439) pg/mL and 119 (62-165) mg/L in ALI/ARDS, and 691 (416-1,194) pg/mL (p < 0.001) and 8 (2-42) mg/L (p < 0.001) in CPE. BNP or CRP alone offered good discriminatory performance (C-statistics 0.831 and 0.887), but the combination offered greater one [C-statistics 0.931 (p < 0.001 versus BNP) (p = 0.030 versus CRP)]. In multiple logistic-regression, BNP and CRP were independent predictors for the diagnosis after adjusting for other variables.
Conclusions
Measurement of CRP is useful as well as that of BNP for distinguishing ALI/ARDS from CPE. Furthermore, a combination of BNP and CRP can provide higher accuracy for the diagnosis.