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
- 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
Fixed threshold ≤300 ng/L to exclude AHF
| Group | AUC | Sensitivity | Specificity | Negative predictive value |
|---|---|---|---|---|
| Fixed threshold ≤300 ng/L | 0.73 (0.69-0.77) | 97.9% (96.9-98.5) | 46.2% (36.4-56.2) | 97.0% (96.5-97.4) |
Further pooled results
| Outcome | Fixed threshold ≤300 ng/L | Age-dependent thresholds | |
|---|---|---|---|
| Patients with CKD (subgroup, N=2,271) | |||
| AUC | Not reported in the abstract | 0.77 (0.75-0.78) | Fixed threshold ≤300 ng/L: not reported in the abstract |
| Specificity | Not reported in the abstract | 62.6% (59.4-65.7) | Fixed threshold ≤300 ng/L: not reported in the abstract |
| Patients with obesity (body mass index ≥30) (subgroup) | |||
| AUC | Not reported in the abstract | 0.82 (0.81-0.84) | Fixed threshold ≤300 ng/L: not reported in the abstract |
| Sensitivity | Not reported in the abstract | 81.2% (79.2-83.1) | Fixed threshold ≤300 ng/L: not reported in the abstract |
- Age-dependent thresholds
- 0.84 (0.83-0.85) · AUC · sensitivity 85.9% (85.0-86.7) · specificity 82.0% (81.2-82.9)
- Patients with CKD (subgroup, N=2,271) — all fixed thresholds yielded AUC
- <0.80
- Age-dependent thresholds: evaluated in 14,410 patients
- Patients with obesity (body mass index ≥30) (subgroup): only age-dependent thresholds were assessed, in 3,562 patients
Patients with obesity (body mass index ≥30) (subgroup)
- Broadly comparable to the overall population
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.
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Summarised from the published abstract; every number is checked against it