Aim Study of shortness of breath (SOB) point-of-care biomarker panel in patients presenting with shortness of breath in Emergency Department.

Objective To study the sensitivity and specificity of SOB point-of-care biomarker panel in diagnosing Acute Coronary Syndrome (ACS), Heart Failure (HF) and Pulmonary Embolism (PE).

Background Shortness of breath (SOB) is one of the commonest symptoms of patients presenting to the emergency department (ED).

The differential diagnosis of SOB is very vast, knowing the frequency and severity potential of ACS, HF and PE should be considered.

Methods/Design 165 consecutive subjects 18 or more years old, presenting to the ED due to a primary complaint of SOB were included in this prospective study.

After detailed history and thorough physical examination, the blood samples of patients included in the study were analysed using a SOB point-of-care biomarker panel (troponin I, myoglobin, CK-MB, D-dimer, and BNP at the time when patient presented with SOB within 15 minutes of patient’s visit to the ED. Thirty-day follow-up for HF, ACS and PE was performed.

The following cut offs were used for determining a positive biomarker:

1. myoglobin > 107 ng/mL,

2. CK-MB > 4.3 ng/mL,

3. troponin I > 0.40 ng/mL,

4. D-dimer > 500 ng/mL, and

5. BNP > 100 ng/mL.

CTCA, CTPA and 2D Echo were taken as the Gold Standard for the diagnosis of ACS, HF and PE.

Results/Conclusions SALIENT FINDINGS

ACS:

P<0.001

Sensitivity=81.2%

Specificity=90.6%

PPV=78%

NPV=92.2%

Accuracy=87.8%

PE:

P<0.001

Sensitivity=75%

Specificity=94.6%

PPV=77.4%

NPV=93.1%

Accuracy=90.3%

HF:

P<0.001

Sensitivity=69.1%

Specificity=66.4%

PPV=50.7%

NPV=81.1%

Accuracy=67.3%

Conclusion We conclude that there is significant correlation between SOB point-of-care biomarker panel diagnosis and final diagnosis.

In patients presenting with SOB, one of the three clinical conditions identified by the SOB point-of-care biomarker panel will lead to earlier diagnosis and initiation of specific management.