Age- and gender-specific brain natriuretic peptide (BNP) reference ranges in primary care

Josephine M. Keyzer, Johannes J. Hoffmann, Lianne Ringoir, Karin C. Nabbe, Jos W. Widdershoven, Victor J. Pop

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Background: 
Chronic heart failure is a common disease with a high morbidity and mortality. In primary care, brain natriuretic peptide (BNP) is used for excluding heart failure. The Dutch and European Society of Cardiology heart failure guidelines apply two BNP cut-off levels without making distinction for gender and age. The aim of our study was to establish BNP reference ranges for use in primary care.
Methods: 
We investigated BNP values of 9447 eligible subjects in a primary care laboratory. For establishing the reference ranges in various age and gender classes we used the Bhattacharya method.
Results: 
Analysis of variance demonstrated that BNP data were significantly dependent on age and gender (p<0.001 and p=0.002, respectively), with the age effect being the strongest. Further, we found that the reference ranges were significantly higher than the cut-off values used in the heart failure guidelines, particularly in elderly subjects. For example, the proportion of individuals with a BNP value higher than the 29 pmol/L cut-off increased from approximately 5% in the youngest group to no less than about 50% in the oldest subjects.
Conclusions: 
BNP reference ranges need to be age- and gender-specific. When applying a single cut-off, many healthy subjects, especially the elderly, would be falsely diagnosed as having elevated BNP, and referred for further unnecessary diagnostics.Keywords: Bhattacharya statistics; brain natriuretic peptide (BNP); chronic heart failure; primary care; reference ranges
Original languageEnglish
Pages (from-to)1341-1346
JournalClinical Chemistry and Laboratory Medicine
Volume59
Issue number9
DOIs
Publication statusPublished - Sep 2014

Keywords

  • Bhattacharya statistics
  • brain natriuretic peptide (BNP)
  • chronic heart failure
  • primary care
  • reference ranges

Cite this

Keyzer, Josephine M. ; Hoffmann, Johannes J. ; Ringoir, Lianne ; Nabbe, Karin C. ; Widdershoven, Jos W. ; Pop, Victor J. / Age- and gender-specific brain natriuretic peptide (BNP) reference ranges in primary care. In: Clinical Chemistry and Laboratory Medicine. 2014 ; Vol. 59, No. 9. pp. 1341-1346.
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title = "Age- and gender-specific brain natriuretic peptide (BNP) reference ranges in primary care",
abstract = "Background: Chronic heart failure is a common disease with a high morbidity and mortality. In primary care, brain natriuretic peptide (BNP) is used for excluding heart failure. The Dutch and European Society of Cardiology heart failure guidelines apply two BNP cut-off levels without making distinction for gender and age. The aim of our study was to establish BNP reference ranges for use in primary care.Methods: We investigated BNP values of 9447 eligible subjects in a primary care laboratory. For establishing the reference ranges in various age and gender classes we used the Bhattacharya method.Results: Analysis of variance demonstrated that BNP data were significantly dependent on age and gender (p<0.001 and p=0.002, respectively), with the age effect being the strongest. Further, we found that the reference ranges were significantly higher than the cut-off values used in the heart failure guidelines, particularly in elderly subjects. For example, the proportion of individuals with a BNP value higher than the 29 pmol/L cut-off increased from approximately 5{\%} in the youngest group to no less than about 50{\%} in the oldest subjects.Conclusions: BNP reference ranges need to be age- and gender-specific. When applying a single cut-off, many healthy subjects, especially the elderly, would be falsely diagnosed as having elevated BNP, and referred for further unnecessary diagnostics.Keywords: Bhattacharya statistics; brain natriuretic peptide (BNP); chronic heart failure; primary care; reference ranges",
keywords = "Bhattacharya statistics, brain natriuretic peptide (BNP), chronic heart failure, primary care, reference ranges",
author = "Keyzer, {Josephine M.} and Hoffmann, {Johannes J.} and Lianne Ringoir and Nabbe, {Karin C.} and Widdershoven, {Jos W.} and Pop, {Victor J.}",
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Age- and gender-specific brain natriuretic peptide (BNP) reference ranges in primary care. / Keyzer, Josephine M.; Hoffmann, Johannes J.; Ringoir, Lianne; Nabbe, Karin C.; Widdershoven, Jos W.; Pop, Victor J.

In: Clinical Chemistry and Laboratory Medicine, Vol. 59, No. 9, 09.2014, p. 1341-1346.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Age- and gender-specific brain natriuretic peptide (BNP) reference ranges in primary care

AU - Keyzer, Josephine M.

AU - Hoffmann, Johannes J.

AU - Ringoir, Lianne

AU - Nabbe, Karin C.

AU - Widdershoven, Jos W.

AU - Pop, Victor J.

PY - 2014/9

Y1 - 2014/9

N2 - Background: Chronic heart failure is a common disease with a high morbidity and mortality. In primary care, brain natriuretic peptide (BNP) is used for excluding heart failure. The Dutch and European Society of Cardiology heart failure guidelines apply two BNP cut-off levels without making distinction for gender and age. The aim of our study was to establish BNP reference ranges for use in primary care.Methods: We investigated BNP values of 9447 eligible subjects in a primary care laboratory. For establishing the reference ranges in various age and gender classes we used the Bhattacharya method.Results: Analysis of variance demonstrated that BNP data were significantly dependent on age and gender (p<0.001 and p=0.002, respectively), with the age effect being the strongest. Further, we found that the reference ranges were significantly higher than the cut-off values used in the heart failure guidelines, particularly in elderly subjects. For example, the proportion of individuals with a BNP value higher than the 29 pmol/L cut-off increased from approximately 5% in the youngest group to no less than about 50% in the oldest subjects.Conclusions: BNP reference ranges need to be age- and gender-specific. When applying a single cut-off, many healthy subjects, especially the elderly, would be falsely diagnosed as having elevated BNP, and referred for further unnecessary diagnostics.Keywords: Bhattacharya statistics; brain natriuretic peptide (BNP); chronic heart failure; primary care; reference ranges

AB - Background: Chronic heart failure is a common disease with a high morbidity and mortality. In primary care, brain natriuretic peptide (BNP) is used for excluding heart failure. The Dutch and European Society of Cardiology heart failure guidelines apply two BNP cut-off levels without making distinction for gender and age. The aim of our study was to establish BNP reference ranges for use in primary care.Methods: We investigated BNP values of 9447 eligible subjects in a primary care laboratory. For establishing the reference ranges in various age and gender classes we used the Bhattacharya method.Results: Analysis of variance demonstrated that BNP data were significantly dependent on age and gender (p<0.001 and p=0.002, respectively), with the age effect being the strongest. Further, we found that the reference ranges were significantly higher than the cut-off values used in the heart failure guidelines, particularly in elderly subjects. For example, the proportion of individuals with a BNP value higher than the 29 pmol/L cut-off increased from approximately 5% in the youngest group to no less than about 50% in the oldest subjects.Conclusions: BNP reference ranges need to be age- and gender-specific. When applying a single cut-off, many healthy subjects, especially the elderly, would be falsely diagnosed as having elevated BNP, and referred for further unnecessary diagnostics.Keywords: Bhattacharya statistics; brain natriuretic peptide (BNP); chronic heart failure; primary care; reference ranges

KW - Bhattacharya statistics

KW - brain natriuretic peptide (BNP)

KW - chronic heart failure

KW - primary care

KW - reference ranges

U2 - 10.1515/cclm-2013-0791

DO - 10.1515/cclm-2013-0791

M3 - Article

VL - 59

SP - 1341

EP - 1346

JO - Clinical Chemistry and Laboratory Medicine

JF - Clinical Chemistry and Laboratory Medicine

SN - 1434-6621

IS - 9

ER -