Heart failure & cardiomyopathies
Diagnostic Accuracy of NT-proBNP thresholds in Dyspneic Patients in the Emergency Department according to patients’ characteristics: A Systematic Review and Meta-Analysis
Authors' conclusion
A threshold ≤300 ng/L provides excellent rule-out performance for AHF, while age-dependent NT-proBNP thresholds offer superior diagnostic performance for ruling in AHF in the ED compared to fixed thresholds, and demonstrate consistent accuracy across subgroups. However, evidence in patients with CKD and obesity remains limited, both in terms of sample size and the range of thresholds evaluated.
Study context
- Population
- Dyspneic patients in the emergency department evaluated for acute heart failure (AHF)patients in 31 studies
- Participants
- 26,948 patients
- Comparison
- diagnostic accuracy of various NT-proBNP thresholds for AHF
- Age-dependent thresholdsn = 14,410
Pooled result
As reported in the abstract
| Strategy | AUC | Sensitivity | Specificity | Negative predictive value |
|---|---|---|---|---|
| Fixed threshold ≤300 ng/L | 0.73 (0.69-0.77) | 97.9% (96.9-98.5)Sensitivity on a scale from 0 to 100 percent | 46.2% (36.4-56.2)Specificity on a scale from 0 to 100 percent | 97.0% (96.5-97.4) |
| Age-dependent thresholds | 0.84 (0.83-0.85) | 85.9% (85.0-86.7)Sensitivity on a scale from 0 to 100 percent | 82.0% (81.2-82.9)Specificity on a scale from 0 to 100 percent | Not reported in the abstract |
AUC
Fixed threshold ≤300 ng/L0.73 (0.69-0.77)
Age-dependent thresholds0.84 (0.83-0.85)
Sensitivity
Fixed threshold ≤300 ng/L97.9% (96.9-98.5)
Age-dependent thresholds85.9% (85.0-86.7)
Sensitivity on a scale from 0 to 100 percentSpecificity
Fixed threshold ≤300 ng/L46.2% (36.4-56.2)
Age-dependent thresholds82.0% (81.2-82.9)
Specificity on a scale from 0 to 100 percentNegative predictive value
Fixed threshold ≤300 ng/L97.0% (96.5-97.4)
Age-dependent thresholdsNot reported in the abstract
Further pooled results
| Outcome | Age-dependent thresholds |
|---|---|
| Patients with CKD (subgroup, N=2,271) | |
| AUC | 0.77 (0.75-0.78) |
| Specificity | 62.6% (59.4-65.7) |
- All fixed thresholds yielded AUC
- <0.80
| Outcome | Age-dependent thresholds |
|---|---|
| Patients with obesity (body mass index ≥30) (subgroup) | |
| AUC | 0.82 (0.81-0.84) |
| Sensitivity | 81.2% (79.2-83.1) |
- Broadly comparable to the overall population
- Only age-dependent thresholds were assessed, in 3,562 patients
Original publication
Diagnostic Accuracy of NT-proBNP thresholds in Dyspneic Patients in the Emergency Department according to patients’ characteristics: A Systematic Review and Meta-Analysis. Eur J Heart Fail. Published 17 October 2026. doi:10.
Summarised from the published abstract; every number is checked against it