Meta-analysis of B-type natriuretic peptide in diagnosis of congestive heart failure in different clinical settings
Bibliographic record
Abstract
Osama E Elkhateeb Iqbal Bata Simon JacksonDalhousie University, Halifax, Nova Scotia, CanadaBackground: B-type natriuretic peptide (BNP) is a neurohormone released from the left ventricle in response to ventricular wall stress and pressure overload. BNP testing has been developed, and aids in identification of patients with suspected congestive heart failure (CHF). The objective of this study was to evaluate the role of BNP as a diagnostic marker of CHF, and determine its value in different clinical settings.Methods: A systematic review and meta-analysis of clinical studies regarding BNP and CHF was conducted. A comprehensive search of Medline, the Cochrane Library, and the reference sections of the primary studies was done. The methodologic quality of each study that met the inclusion criteria was assessed. The results of individual studies were described. The pooled sensitivity and specificity were calculated. Estimation of the diagnostic accuracy was done using meta-regression of the diagnostic odds ratio and summarized by a summary receiver-operating curve (S-ROC).Results: In total, 32 studies (n = 11054) met the inclusion criteria. The overall sensitivity and specificity at the optimum cutoff point are 81% (95% confidence interval: 0.76–0.86) and 86% (95% confidence interval: 0.81–0.89), respectively. The area under the S-ROC for all studies is 0.92. Nine papers included patients with dyspnea. The pooled negative likelihood ratio for this group was 0.12. Five studies included patients with chronic CHF and another seven studies included patients who were referred for echocardiography. The remaining studies were patients from the general population, patients with stable coronary artery disease, and patients referred for cardiac catheterization.Conclusion: BNP is a valuable tool in the diagnosis of CHF. It should be applied in the appropriate clinical setting. The strongest evidence of benefit for use of BNP is in patients presenting to the emergency room with dyspnea.Keywords: B-type natriuretic peptide, congestive heart failure, neurohormone, summary receiver-operating curve, dyspnea
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.025 | 0.033 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.015 | 0.062 |
| Bibliometrics | 0.007 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".