Cardiology · Internal Medicine · 4 h ago
NT-proBNP thresholds show differing accuracy for acute heart failure in the ED
A systematic review and meta-analysis of 31 studies involving 26,948 dyspneic emergency department patients assessed NT-proBNP thresholds for acute heart failure. A fixed threshold of 300 ng/L or lower had high sensitivity for ruling out heart failure, while age-dependent thresholds showed a better overall balance of sensitivity and specificity.
- NT-proBNP ≤300 ng/L had 97.9% sensitivity for ruling out AHF.
- Age-dependent thresholds had 82.0% specificity overall.
- Diagnostic accuracy was lower in patients with CKD.
- Evidence in CKD and obesity remains limited.
NT-proBNP is used to support diagnosis of acute heart failure (AHF) in patients presenting with dyspnea, but the best diagnostic thresholds remain uncertain. This systematic review and meta-analysis included 31 studies published up to August 28, 2025, covering 26,948 emergency department patients. The authors assessed diagnostic accuracy overall and in subgroups, including patients with chronic kidney disease (CKD) and obesity.
For ruling out AHF, a fixed threshold of 300 ng/L or lower had 97.9% sensitivity and 46.2% specificity; its negative predictive value was 97.0%. Age-dependent thresholds—450 ng/L for patients younger than 50 years, 900 ng/L for those aged 50–75, and 1,800 ng/L for those aged 75 or older—had 85.9% sensitivity and 82.0% specificity across 14,410 patients. In patients with CKD, age-dependent thresholds had 62.6% specificity and an area under the curve (AUC) of 0.77. Among patients with obesity, the AUC was 0.82 and sensitivity was 81.2%.
The findings support the high rule-out sensitivity of the 300 ng/L threshold and suggest age-dependent thresholds may better balance diagnostic performance when ruling in AHF. Accuracy was lower in CKD, and evidence for both CKD and obesity was limited by sample size and the range of thresholds evaluated. The abstract does not report assessment of effects on clinical outcomes.
In practice
For adults presenting to the emergency department with dyspnea, the pooled results support using NT-proBNP ≤300 ng/L as a high-sensitivity threshold to help rule out acute heart failure; its specificity was low, so an elevated result does not itself establish the diagnosis. Age-dependent thresholds had a more balanced sensitivity and specificity profile overall, but accuracy was lower in patients with CKD. The evidence does not establish effects on clinical outcomes, and subgroup data—particularly for CKD and obesity—were limited; these findings alone do not justify changing local diagnostic pathways.
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European Journal of Heart Failure: Diagnostic Accuracy of NT-proBNP thresholds in Dyspneic Patients in the Emergency Department according to patients’ characteristics: A Systematic Review and Meta-Analysis ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.