Nūhou

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Pahuhopu No ka loiloi ʻana i ka hana diagnostic o N-terminal B-type natriuretic peptide precursor (NT-proBNP) paepae i ka puʻuwai koʻikoʻi, a e hoʻomohala a hōʻoia i kahi mea kākoʻo hoʻoholo e hoʻohui i ka manaʻo NT-proBNP me nā hōʻailona lapaʻau.
Hana ʻia nā haʻawina 14 mai nā ʻāina he 13, me nā hoʻāʻo hoʻokele randomized a me nā noiʻi nānā ʻana.
Ua hui ʻia ka ʻikepili o ka pae o kēlā me kēia kanaka mai 10 a 369 mau mea maʻi me ka puʻuwai puʻuwai i manaʻo ʻia no kahi meta-analysis e koho i nā ʻoki NT-proBNP.ʻO kahi mea hana hoʻoholo hoʻoholo (Heart Failure Diagnosis and Evaluation Collaboration (CoDE-HF)), e hui pū ana i ka NT-proBNP me nā ʻano hoʻololi lāʻau lapaʻau e hōʻike i ka likelihood o ka puʻuwai puʻuwai i loko o kēlā me kēia maʻi, ua kūkulu ʻia a hōʻoia ʻia.
Nā hualoaʻa.ʻO ka holoʻokoʻa, 43.9% (4549/10 ~ 369) o nā maʻi i loaʻa i ka puʻuwai puʻuwai koʻikoʻi (73.3% (2286/3119) a me 29.0% (1802/6208) o nā maʻi me ka ʻole o ka naʻau mua.ʻO ka paepae ʻoki ʻia a ka luna hoʻokele i manaʻo ʻia he 300 pg/mL he waiwai wānana maikaʻi ʻole o 94.6% (95% ka manawa hilinaʻi, 91.9% a 96.4%); ʻoiai ka hoʻohana ʻana i nā paepae kikoʻī o ka makahiki, ʻokoʻa ka waiwai wānana maikaʻi ma 61.0% (55.3% a 66.4%), 73.5% (62.3% a 82.3%), a me 80.2% (70.9% a 87.1%), i nā maʻi o ka makahiki. <50 makahiki, 50-75 makahiki, a me >75 makahiki. ʻoiai ka hoʻohana ʻana i nā pae kānāwai maʻamau, ʻokoʻa ka waiwai wānana maikaʻi ma 61.0% (55.3% a 66.4%), 73.5% (62.3% a 82.3%), a me 80.2% (70.9% a 87.1%), i nā maʻi. makahiki <50 makahiki, 50-75 makahiki, a me >75 makahiki. Несмотря на использование возрастных порогов правил, положительная прогностическая ценность варьировала в 61,0% , 61,0% (3% д %), 2% от д 61,0% (3% д %) (mai 70,9% a hiki i 87,1%) у пациентов в возрасте <50 лет, 50-75 лет и >75 лет соответственно. ʻOiai ka hoʻohana ʻana i nā paepae makahiki i nā lula, ua ʻokoʻa ka waiwai wānana maikaʻi ma 61.0% (mai 55.3% a 66.4%), 73.5% (mai 62.3% a i 82.3%) a me 80.2% (mai 70.9% a i 87.1%) i nā maʻi. makahiki <50 makahiki, 50-75 makahiki a >75 makahiki.ʻOiai ka hoʻohana ʻana i nā paepae makahiki i ka lula, i waena o nā poʻe maʻi kahiko, ʻo nā helu wānana maikaʻi ʻo 61.0% (ma waena o 55.3% a 66.4%), 73.5% (ma waena o 62.3% a 82.3%) a me 80. 2% (mai 70.9). % i ka 87.1%).) hoʻololi ma waena. <50 岁、50-75 岁和>75 岁。 <50岁、50-75岁和>75岁. <50 лет, 50-75 лет и >75 лет. <50 makahiki, 50-75 makahiki a >75 makahiki.Ua ʻokoʻa nā hōʻike maʻi ma ka hapa nui o nā pūʻulu, ʻoi aku ka nui o nā pūʻulu me ka momona, ka lawa ʻole o ka renal, a i ʻole ka mōʻaukala o ka naʻau ʻole.Ua hoʻoponopono maikaʻi ʻia ʻo CoDE-HF a loaʻa i ka hoʻokae maikaʻi loa ma waena o nā maʻi me ka ʻole o ka moʻolelo o ka naʻau ʻole (wahi ma lalo o ka pihi hana hoʻokipa 0.846 (0.830 a i 0.862) a me 0.925 (0.919 a i 0.932), kēlā me kēia, a me ka helu Brier o 0.130 a 0.099, kēlā me kēia).).I nā poʻe maʻi me ka ʻole o ka naʻau ma mua, ua kūlike ka maʻi ma waena o nā pūʻulu āpau me ka haʻahaʻa haʻahaʻa o 40.3% (2502/6208) (negative predictive value 98.6%, 97.8% a i 99.1%) a me 28.0% (1737/6208) ka likelihood o Ua kiʻekiʻe ka hāʻule ʻana o ka naʻau (ka waiwai wānana maikaʻi 75.0%, 65.7% a i 82.5%).
Nā Manaʻo Manaʻo I loko o ka loiloi hui like ʻana o ka hana diagnostic o NT-proBNP, ua ʻano like ʻole nā ​​paepae i ʻōlelo ʻia i loko o nā alakaʻi no ka hoʻomaʻamaʻa ʻana i ka puʻuwai koʻikoʻi ma waena o nā pūʻulu maʻi koʻikoʻi.Hoʻohui ka CoDE-HF Decision Support Tool i ka NT-proBNP i nā ana mau a me nā ʻano hoʻololi ʻē aʻe, e hāʻawi ana i kahi ʻano kūlike, pololei a pilikino.
Ma kahi kokoke i 1 miliona mau kānaka ma UK e loaʻa i ka puʻuwai puʻuwai a ke manaʻo nei e piʻi aʻe ka maʻi ma kahi o 50% i nā makahiki 25 e hiki mai ana ma muli o ka heluna kanaka ʻelemakule.1 ʻO ka pau ʻana o ka puʻuwai puʻuwai decompensated he 5% o nā hale maʻi i hoʻolālā ʻole ʻia.2 He mea paʻakikī ka hōʻoia pololei a me ka manawa kūpono o ka hōʻino ʻana o ka naʻau, a ua ʻōlelo nā alakaʻi aupuni a me ka honua i ka hoʻāʻo ʻana i nā peptides natriuretic e kōkua i ka maʻi maʻi.345678 Me kēia mau ʻōlelo paipai, ʻaʻole i hana mau ʻia ka hoʻāʻo ʻana i ka N-terminal B-type natriuretic peptide precursor (NT-proBNP), ma kekahi hapa no ka hopohopo e pili ana i kona pono lapaʻau i ka honua maoli.ʻO nā haʻawina e noiʻi ana i ka hana diagnostic o NT-proBNP ua alakaʻi nui ʻia i loko o nā pūʻulu liʻiliʻi i koho ʻia o nā maʻi, e kaupalena ana i ka hiki ke hoʻonui i nā hopena i nā subgroup koʻikoʻi koʻikoʻi, e like me nā poʻe maʻi ʻelemakule a me nā maʻi me ka lawa ʻole o ka renal a i ʻole ka momona, kahi i ʻokoʻa ai kēia mau ʻano. maikaʻi.ʻoi aku ka maʻamau i nā poʻe maʻi me ka hāʻule ʻole o ka naʻau.91011 ʻO nā ala hoʻohālike helu helu e noʻonoʻo ana i nā hiʻohiʻona o ka maʻi e hāʻawi i nā koho pilikino ʻoi aku ka nui o ka hana diagnostic ma waena o nā ʻāpana o nā maʻi.12
ʻOiai ua kūkulu ʻia nā hiʻohiʻona he nui e wānana i ka wānana i nā poʻe maʻi me ka puʻuwai naʻau, hiki i nā mea hoʻohālike ke kōkua i ka hōʻoia ʻana i ka hōʻeha ʻole o ka naʻau.13141516171819 Ua loaʻa i nā hoʻāʻo mua he nui nā pōmaikaʻi akā ua hoʻokomo ʻia nā mea hoʻololi kumuhana e like me nā probabilities o ka hoʻāʻo mua ʻana o nā kauka a i ʻole ka wehewehe ʻana i nā hōʻailona.Eia kekahi, ua hoʻokomo lākou i ka NT-proBNP ma ke ʻano he hoʻololi binary a ʻaʻole i noʻonoʻo i nā pilina ikaika a me ka laina ʻole ma waena o NT-proBNP a me nā mea hoʻololi ʻē aʻe.ʻO nā ho'āʻo mua e hoʻomohala a hōʻoia i nā unahi diagnostic ua hoʻokomo pū kekahi i kahi helu palena o nā maʻi mai kahi hale hoʻokahi, kahi i kāohi ai i ka loiloi o ka pono i loko o nā pūʻulu liʻiliʻi a kaupalena i ka hiki ke hoʻonui i waho.
I loko o kēia loiloi honua hui pū ʻana, ua loiloi mākou i ka hana diagnostic o nā paepae NT-proBNP i ʻōlelo ʻia e nā alakaʻi no ka hāʻule ʻana o ka naʻau ma kahi ʻāpana o nā maʻi.Ma hope mai, ua hoʻomohala a hōʻoia mākou i kahi mea hana kākoʻo hoʻoholo no nā poʻe maʻi i manaʻo ʻia me ka hōʻeha ʻole o ka naʻau i hoʻohana i kahi ʻano helu helu e hoʻohui i nā manaʻo NT-proBNP me nā ʻano lapaʻau.
Ua alakaʻi mākou i kahi loiloi ʻōnaehana e ʻike i nā haʻawina e loiloi ana i ka hana diagnostic o NT-proBNP i nā poʻe maʻi me ka manaʻo ʻole o ka puʻuwai puʻuwai.Ua hōʻano hou mākou i kahi loiloi mua e Roberts et al1 e hoʻokomo i nā huaʻōlelo "heart failure" a me "natriuretic peptides" ma ka ʻimi ʻana iā Embase, Medline, a me ka Cochrane Central Register of Controlled Trials no nā poʻo inoa a me nā abstract i paʻi ʻia ma 18 ʻAukake 2021 (Supplementary Text 1) .Ua manaʻo ʻia he kūpono nā haʻawina inā hoʻokō lākou i nā pae hoʻohui i koho mua ʻia: ke kākau inoa ʻana o nā mea maʻi ≥18 mau makahiki me ka manaʻo o ka puʻuwai puʻuwai i manaʻo ʻia i ka hoʻonohonoho ulia pōpilikia, ana o NT-proBNP i nā koko koko i loaʻa i ka wā o ka loiloi mua o ka mea maʻi i ka lā o ke komo ʻana, a Ua hana ʻia ka maʻi o ka puʻuwai puʻuwai me ka hoʻohana ʻana i nā maʻamau kuhikuhi kūpono.Ua nānā kūʻokoʻa nā mea noiʻi ʻelua (KKL a me MA) i nā noiʻi āpau i ʻike ʻia e kahi hulina palapala systematic, a ʻo ke kolu (NLM) i hoʻoholo i ka hakakā me ka hoʻohana ʻana i kahi protocol predefined (PROSPERO registry: CRD42019159407).
Ua hoʻokaʻaʻike mākou i nā mea kākau no nā cohorts kūpono a pau e noi i ka ʻike e pili ana i ka NT-proBNP concentrations, hōʻoia i ka hōʻoia ʻana o ka puʻuwai puʻuwai koʻikoʻi, demographics (makahiki, ke kāne, lāhui), ka mōʻaukala mua (ka puʻuwai puʻuwai, ka maʻi coronary artery, ka pae maʻi kanaka ʻole).ʻikepili e pili ana i ka maʻi diabetes), ke kiʻekiʻe, hyperlipidemia, puhi paka, hānō, maʻi obstructive pulmonary maʻi, maʻi maʻi maʻi maʻi), nā ʻāpana physiological (ka puʻuwai puʻuwai a me ke kahe koko) i ka hoʻokolokolo mua ʻana, nā ʻano haematological a me nā ʻano biochemical.Ua nānā mākou me nā mea kākau kūpono a pau no ka pololei, ka wehewehe ʻana o nā ʻano like ʻole, a me ka piha ma mua o ka ʻaelike.Ua mālama ʻia nā haʻawina āpau e like me ka Hōʻike o Helsinki a ua ʻae ʻia e kaʻana like i ka ʻikepili i kēlā me kēia pae maʻi no kēia meta-analysis.ʻElua mau mea noiʻi (KKL a me MA) i loiloi kūʻokoʻa i ka pilikia o ke ʻano no kēlā me kēia haʻawina e hoʻohana ana i ka Study Quality Assessment Tool in Diagnostic Accuracy, version 2 (QUADAS-2), a ua hoʻoholo ʻia nā paio 20 e kekahi ʻaoʻao ʻekolu (NLM).
Ua loaʻa iā mākou nā meta-estimates me 95% mau manawa hilinaʻi o ka sensitivity, specificity, negative predictive value, and positive predictive value of the guideline NT-proBNP rule-out threshold (300 pg/mL)58 a me nā makahiki kikoʻī lula-in thresholds ( 450, 900, a me 1800 pg/mL no nā poʻe maʻi ma lalo o 50, 50-75, a me> 75 makahiki, kēlā me kēia) 7 no ka pau ʻole o ka naʻau ma o ka hoʻohana ʻana i kahi ala ʻelua ʻanuʻu, me nā manaʻo i helu ʻia i loko o kēlā me kēia haʻawina a laila hui ʻia ma waena o nā haʻawina. i loko o ka binomial-normal random effects model me ka DerSimonian and Laird method.21 Ua loiloi hou mākou i ka hana ʻana o kēia mau paepae ma nā pūʻulu i hoʻopaʻa mua ʻia e ka makahiki, ke kāne, ka lāhui, ka helu kino kino, ka hana renal, anemia, a me ke alo o nā comorbidities (ka hāʻule o ka naʻau ma mua, hypertension, hyperlipidemia, diabetes mellitus, fibrillation atrial, maʻi pulmonary obstructive mau). Мы получили метаоценки с 95% доверительными интервалами чувствительности, специфичности, отрицательной прогностической ценности и положительной прогностической ценности рекомендуемого порога исключения NT-proBNP (300 пг/мл)58 и возрастных порогов исключения ( 450, 900 и 1800 пг/мл для пациентов в возрасте < 50, 50-75 и >75 лет соответственно)7 для острой сердечной недостаточности с использованием двухэтапного подхода, при этом оценки рассчитываются отдельно в каждом исследовании, а затем объединяются по исследованиям.в модели биномиально-нормальных случайных эффектов с использованием метода ДерСимониана и Лэрда.21 Далее мы оценили эффективность этих пороговых значений в предварительно определенных подгруппах, стратифицированных по возрасту, полу, этнической принадлежности, индексу массы тела, функции почек, анемии и наличию сопутствующие заболевания (сердечная недостаточность в анамнезе, артериальная гипертензия, гиперлипидемия, сахарный диабет, мерцательная гипертензия, гиперлипидемия, сахарный диабет, мерцательная ахритльная ахритромичесть我们 对 指南指南指南 I推荐 Hawaiian IL-300 PG / ML - 5000 pg Ako) 7, 采用 采用 阶段, 在, 在 二 估计值 进 进中 进中 进使用 进使用 阈值阈值 阈值 阈值阈值 阈值 阈值 阈值 阈值 阈值 阈值 阈值 阈值 阈值 阈值 阈值 阈值 阈值 阈值 阈值 阈值 阈值 阈值 阈值 阈值 阈值 阈值 阈值 阈值 阈值 阈值 阈值 阈值 阈值按按, 性别 种族, 种族, 体重 功能, 贫血 功能, 既往, 高, 慢性, 慢性 慢性 阻塞 颤动).我们 对 指南 的 nt-probnp 排除 排除 (300) 排除> 对于对于 和 (1000 С700 和 1800 т 1800 9. 9. 9 n- 7 ‡. / М 急性, 和 (9 200 т 1800 9 Anei) 7, 采用 阶段阶段 在, 在 研究 中 中 中 效应 中 中 中 中 效应随机 随机中 中中 效应 ....我们F评估评估 种族按性别, 体重 指数, 肾 存在 衰竭 (既往 血压 衰竭衰竭, 慢性 慢性 肺病) ....使用 相同 相同, 我们 随后 一评估 了 n-系列-系列范围 的 最, 患者 具有 的 阴性 预测值 患者 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 患者 预测值 预测值 患者 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 患者 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 预测值 to≥ 78% ≥ 预测值 具有
Ua helu mākou i kahi waiwai (0-100) e pili ana i ka hoʻomohala ʻana i ka puʻuwai puʻuwai koʻikoʻi i loko o kahi mea maʻi e hoʻohana ana i ka hoʻohālike helu.Ma muli o nā ʻokoʻa koʻikoʻi i ka laha ʻana o nā comorbidities a me ka puʻuwai puʻuwai koʻikoʻi, ua kūkulu mākou a hōʻoia i nā hiʻohiʻona no nā maʻi me ka ʻole o ka puʻuwai puʻuwai.Ua hoʻohana mākou i nā manaʻo koʻikoʻi NT-proBNP ma ke ʻano he ana mau a koho ʻia nā ʻano hoʻololi maʻalahi maʻalahi i ʻike ʻia e pili ana me ka puʻuwai puʻuwai koʻikoʻi i ʻoi aku ka koʻikoʻi pili i ka wā o ke aʻo ʻana o kā mākou kumu hoʻohālike (makahiki, manaʻo ʻia ka helu kānana glomerular, hemoglobin, nā kino helu helu lehulehu. )., ka pu'uwai, ke koko, ka edema peripheral, ka ma'i pulmonary obstructive mau a me ka ma'i pu'uwai ischemic) (He kikokikona hou 2).
I ka hoʻomohala ʻana i ka Code-HF, ua loiloi mākou i ʻehā mau ʻano helu helu: Generalized Linear Mixed Models, Naive Bayes, Random Forest, a me Extreme Gradient Boost (XGBoost) (Supplementary Text 2).222324 No ka helu ʻana i ka ʻikepili nalo i loko o nā haʻawina (Supplementary Figure A), ua hoʻonui mākou i ka helu helu 10 i hoʻohana ʻia me ka hoʻohana ʻana i ka imputation lehulehu i hoʻohālikelike ʻia me kahi matrix covariance matrix i hoʻopaʻa ʻia e pili ana i kahi algorithm chain Monte Carlo Markov.25 Ua hana mākou i nā imputation he nui no nā mea hoʻololi āpau i hoʻokomo ʻia i loko o ke kŘkohu koe wale no NT-proBNP.Ua hana mākou i 10 iterations o 10-fold cross-validation no kēlā me kēia kŘkohu a hoʻohana i ka manaʻo median o ka iteration a me ka helu helu helu e like me ka helu CoDE-HF no kēlā me kēia maʻi.Ma hope mai, ua ʻike mākou i nā helu i hoʻokaʻawale i ka hapa nui loa o nā maʻi me ke kiʻekiʻe a haʻahaʻa paha o ka puʻuwai puʻuwai, me ka hana maikaʻi loa no ka haʻalele ʻana (75% waiwai wānana maikaʻi a me 90% kikoʻī) a no ka wehe ʻana (98% waiwai wānana maikaʻi ʻole a me 90 % kiko'ī) % sensitivity) i loko o ka puʻuwai koʻikoʻi.
Ua loiloi mākou i ka hana o kēlā me kēia kŘkohu ma ke ʻano o nā metric diagnostic (wahi ma lalo o ka pihi hana hoʻokipa, helu Brier, ka hapa o nā mea maʻi e hoʻokō ana i nā koina kūpono kūpono a haʻahaʻa, a me nā waiwai wānana maikaʻi a maikaʻi ʻole no nā pūʻulu o nā maʻi).ʻO ka helu Brier he ʻano hoʻokae a me ke ana ʻana i helu ʻia ma ka lawe ʻana i ka hewa maʻamau ma waena o nā probabilities a me nā ʻike.26 Ua koho mākou i ke kumu hoʻohālike maikaʻi loa no ka hāmeʻa kākoʻo hoʻoholo Code-HF.Loiloi mākou i ka hana o CoDE-HF me ka hoʻohana ʻana i ka hoʻopaʻa ʻana i ka pihi hoʻoholo a me ka hōʻoia ʻana i loko a me waho.ʻO ka pōkole, ʻaʻole hoʻokaʻawale kēia ala i hoʻokahi haʻawina i ka manawa no ka hōʻoia o waho a hoʻohana i nā haʻawina i koe e hoʻomohala i ke kumu hoʻohālike.27 ʻAʻole mākou i hoʻokomo i nā waiwai i loko o nā ʻikepili i hōʻoia ʻia i waho a no laila ʻaʻole i hōʻoia i waho no ka hapa nui o nā haʻawina.ʻAʻole loa ka hoʻololi ʻana (Hoʻohui Kiʻi A).Ua hoʻohana mākou i ka mana R 4.1.2 no nā loiloi āpau.
Ua komo nā maʻi a me nā lālā o ke komisina aupuni i ka wehewehe ʻana i nā hopena.Aia nā hoʻolālā e hoʻolaha i nā hopena i ke kaiāulu maʻi kūpono.
Hoʻopili mākou i nā mea noiʻi mai 30 mau haʻawina kūpono, a ʻo 19 i pane mai.He ʻumikūmāhā mau haʻawina (12 prospective cohort study and two randomized controlled trials) i hāʻawi i kēlā me kēia kanaka maʻi-level data mai 10 a hiki i 369 mau maʻi me ka manaʻo ʻole o ka puʻuwai puʻuwai (mean makahiki 69.3 makahiki; 53.3% kāne) mai nā ʻāina 13 (Table 1).Kiʻi B;Nā Papa Pākuʻi A a me B) 1528293031323334353637383940 Ua mālama ʻia nā haʻawina a pau ma ke keʻena pilikia, koe naʻe kahi haʻawina i komo pū me nā maʻi maʻi cardiac a me ka pulmonary (mean 488 mau maʻi i kēlā me kēia haʻawina (quartile. Bit spacing 322-1053)).Ma keʻano holoʻokoʻa, 43.9% (4549/10,369) o nā mea maʻi i hōʻoia i ka hōʻoia ʻana o ka hōʻino ʻole o ka naʻau (median study prevalence 46% (31-54%)).I nā poʻe maʻi me ka naʻau mua o ka naʻau, ʻoi aku ka kiʻekiʻe o ka ulu ʻana o ka puʻuwai puʻuwai ma mua o nā maʻi me ka ʻole o ka puʻuwai puʻuwai (73.3% (2286/3119) vs. 29.0% (1802/6208)) (Supplementary Table C).
Nā hiʻohiʻona kumu o nā maʻi i hoʻopaʻa ʻia e ka maʻi o ka puʻuwai puʻuwai.He helu (pakeneka) nā waiwai ke ʻole i ʻike ʻia
Ma ka paepae hoʻokuʻu ʻia ʻana o ke alakaʻi o 300 pg/mL, ʻo ka hui ʻana o ka meta-estimation o ka waiwai wānana maikaʻi ʻole, ka naʻau, ka waiwai wānana maikaʻi, a me ka kikoʻī o NT-proBNP i ka heluna lehulehu he 94.6% (95% hilinaʻi wā, 91.9%). .i 96.4%), 96.8% (mai 94.6% a i 98.1%), 62.9% (mai 51.3% a i 73.3%) a me 49.3% (mai 35.4 % a i 63.4%) (Figure 1; Pākuʻi Papa D).ʻO ka holoʻokoʻa, 30.4% (3148/10,369) o nā maʻi i loaʻa nā pae NT-proBNP ma lalo o 300 pg / mL.Eia nō naʻe, ua ʻike ʻia ka heterogeneity ma waena o nā subgroup a me nā haʻawina (Figure 2; Figure 3; Nā Kiʻi Hoʻohui C a me D).He haʻahaʻa nā waiwai wānana maikaʻi ʻole i nā maʻi ≥75 mau makahiki (88.2%, mai 83.5% a 91.8%), a me nā mea maʻi me ka mōʻaukala o ka puʻuwai puʻuwai (79.4%, mai 68.4% a 87.3%) a me ka momona. (90.4%, mai 84.5% a i 87.3%).94.2%.
ʻO ka paepae N-terminal o pro-B-type natriuretic peptide (NT-proBNP) i ka hāʻule ʻole o ka naʻau.Hema hema: Waiwai wānana maikaʻi ʻole o ka NT-proBNP hoʻopaʻa ʻana e kāpae i ka hōʻailona o ka hāʻule ʻana o ka naʻau.Ma lalo hema: ʻO ka huina kumulative o nā maʻi i manaʻo ʻia me ka hōʻino ʻole ʻana o ka naʻau me ka NT-proBNP ʻokoʻa ma lalo o kēlā me kēia paepae.ʻAkau ʻākau: Waiwai wānana maikaʻi o ka NT-proBNP hoʻopaʻa ʻana no ka hōʻoia ʻana o ka hāʻule ʻole o ka naʻau.Ma lalo akau: ʻO ka huina kumulative o nā mea maʻi i manaʻo ʻia me ka hōʻino ʻole o ka naʻau me ka NT-proBNP ʻoi aku ma luna o kēlā me kēia paepae.
ʻO ka hana diagnostic o nā alakaʻi-i ʻōlelo ʻia nā paepae N-terminal no ka pro-B-type natriuretic peptide i nā subgroups maʻi: ka paepae waiwai wānana maikaʻi ʻole o 300 pg / mL.COPD = ka maʻi obstructive pulmonary maʻi;eGFR = ka nui o ka kānana glomerular
ʻO ka hana diagnostic o ke alakaʻi i ʻōlelo ʻia nā paepae NT-proBNP ma waena o nā pūʻulu maʻi: waiwai wānana maikaʻi o nā paepae kikoʻī o nā makahiki ma waena o nā pūʻulu maʻi (450, 900, a me 1800 pg/mL no <50, 50-75, a me> 75 makahiki, kēlā me kēia). ʻO ka hana diagnostic o ke alakaʻi i ʻōlelo ʻia nā paepae NT-proBNP ma waena o nā pūʻulu maʻi: waiwai wānana maikaʻi o nā paepae kikoʻī o nā makahiki ma waena o nā pūʻulu maʻi (450, 900, a me 1800 pg/mL no <50, 50-75, a me> 75 makahiki, kēlā me kēia). Диагностическая эффективность рекомендованных в руководстве порогов NT-proBNP для подгрупп пациентов: положительная прогностическая ценность возрастных порогов для подгрупп пациентов (450, 900 и 1800 пг/мл для <50, 50-75 и >75 лет соответственно). ʻO ka hana diagnostic o nā paepae NT-proBNP i manaʻo ʻia no ke alakaʻi no nā pūʻulu maʻi: ka waiwai wānana maikaʻi o nā paepae makahiki no nā pūʻulu maʻi (450, 900, a me 1800 pg/mL no <50, 50-75, a me> 75 makahiki, kēlā me kēia) .指南 推荐 的 跨患者跨患者 的 t-pro-的 诊断 亚组 的 阳性 的 阳性阈值 (分别分别 预测值 1800 和> 50,50-50-75 7> 7,50-50-50-75 7> )-50-75 7> )-50-75 7> )-50-75 7> )-50-75 7> )-50-75 7> )-50-75 7> )-50-75 7> )-50-75 7> )-50-75 7> )-50-75 7> )-50-75 7> )-50-75 7> )-50-75 7> )-50-75 7> )-50-75 7> )-50-75 7> )-50-75 7> )-50-75 7> )-50-75 7> )-50-75 7> )-50-75 7> )-50-75 7> )-50-75 7> )-50-75 7>岁）.指南指南 的 跨患者跨患者 n proтnp o 阈值 的 跨患者 亚组 的 阳性 "跨患者 (分别 为) 阳性 1800 l) 和> 4 7,50 和). Диагностическая эффективность порогов NT-proBNP, рекомендованных руководством, для подгрупп пациентов: положительная прогностическая ценность возрастных порогов для подгрупп пациентов (450, 900 и 1800 пг/мл, <50, 50-75 и >75 соответственно возрасту) . ʻO ka hana diagnostic o nā alakaʻi-manaʻo ʻia nā paepae NT-proBNP no nā pūʻulu maʻi: waiwai wānana maikaʻi o nā paepae kikoʻī makahiki no nā pūʻulu maʻi (450, 900, a me 1800 pg/mL, <50, 50-75, a me>75, kēlā me kēia no ka makahiki. ).COPD = ka maʻi obstructive pulmonary maʻi;eGFR = ka nui o ka kānana glomerular
ʻO ka pooled meta-estimations o ka maikaʻi wānana waiwai o ka makahiki oki-offs o ka NT-proBNP 450, 900, a me 1800 pg/mL rula he 61.0% (55.3% i 66.4%), 73.5% (62.3% i 82 . 3%) a me 80.2%, i kēlā me kēia (70.9% i 87.1%) (Papa 2).ʻO nā mea kiko'ī e pili ana he 87.8% (79.5% a 93.0%), 81.1% (72.6% a 87.5%), a me 73.1% (65.2% a 79. ewalu%).ʻO ka holoʻokoʻa, 48.7% (5052/10,369) o nā mea maʻi i manaʻo ʻia ʻaʻole i loaʻa ka NT-proBNP ma luna o kēia mau pae makahiki.ʻOiai ka heterogeneity ma waena o nā pūʻulu makahiki, ka hana ʻana o ka puʻuwai, a me ka nui o ka puʻuwai puʻuwai koʻikoʻi, i loko o nā pūʻulu liʻiliʻi, ʻoi aku ka maikaʻi o ka ʻoki ʻana o nā lula ma luna o kahi ʻoki hoʻokahi o 300 pg/mL (Supplementary Figure EI) .
ʻO ka hana diagnostic o ka N-terminal B-type natriuretic peptide precursor (NT-proBNP) pae makahiki no ka hāʻule ʻana o ka naʻau.
Ma ke ʻano holoʻokoʻa, ua ʻike mākou i ʻehiku mau haʻawina i ke kiʻekiʻe kiʻekiʻe o ka bias (Supplementary Table A).I ka hoʻopaʻa ʻana i ka naʻau i kaupalena ʻia i nā haʻawina i makapō i ka NT-proBNP ʻona no ka hoʻoponopono ʻana i ka hōʻino ʻole o ka naʻau a me nā haʻawina me ka haʻahaʻa haʻahaʻa haʻahaʻa, ʻaʻole i hoʻololi ʻia nā alakaʻi i nā hiʻohiʻona diagnostic a me nā ʻoki makahiki no NT-proBNP (Supplementary Tables E a me F. )..
Ua hoʻokō ka paepae 100 pg/mL NT-proBNP i kā mākou mau ʻōlelo hoʻokaʻawale maikaʻi loa me kahi waiwai wānana maikaʻi ʻole o 97.8% (ma waena o 95.8% a 98.8%) a me kahi sensitivity o 99.3% (ma waena o 98.5% a 99.7%) (Paʻi Pākuʻi D) .Eia nō naʻe, ʻo 17.9% wale nō (1851/10~369) o nā maʻi i loaʻa i ka NT-proBNP ʻoi aku ma lalo o 100 pg/mL, a maikaʻi ʻole lākou i nā poʻe maʻi kahiko a me nā mea maʻi me ka hāʻule ʻole o ka naʻau, ka maʻi coronary artery, a me ka mōʻaukala o nā maʻi. ..ʻO ka hana ʻāʻī (Hui J).Pēlā nō, ua hoʻokō ka 1000 pg/mL NT-proBNP cut-off i kā mākou mau loiloi loiloi maikaʻi loa me ka waiwai wānana maikaʻi o 74.9% (64.4% a i 83.2%) a me kahi kikoʻī o 76.1% (65.6% a i 84.2%).ua haʻahaʻa.ʻokoʻa.He haʻahaʻa hoʻi ia i nā pūʻulu maʻi, ʻoi aku ka poʻe me ka mōʻaukala ʻole o ka naʻau o ka naʻau (ka waiwai wānana maikaʻi ʻo 62%, 41% a i 79%) (Paʻi Paʻi D; Kiʻi K).
ʻO ke ʻano hoʻohālikelike hoʻonui gradient nui (XGBoost) a me ke ʻano huila linear ākea nā hiʻohiʻona hana maikaʻi loa (wahi ma lalo o ka pihi i ka hui hoʻomaʻamaʻa holoʻokoʻa 0.925 (95% CI 0.919 a i 0.932) a me 0.931 (0.925 a i 0.937), kēlā me kēia. kikokikona 2) .ʻOiai ʻo ka hana o XGBoost e like me nā hiʻohiʻona huila laina laulā, ʻo ka pōmaikaʻi nui o XGBoost ʻo ia ka hiki ke helu i nā helu ke loaʻa nā waiwai.He hiʻohiʻona koʻikoʻi kēia a mākou e manaʻo nei e hoʻokō i ka hāmeʻa kākoʻo hoʻoholo CoDE-HF e hoʻomaʻamaʻa i kāna hoʻokō ʻana i ka hana lapaʻau, ʻo ia ke kumu i koho ai mākou i ke kumu hoʻohālike XGBoost i kumu hoʻohālike hope loa no CoDE-HF.
Hoʻoponopono maikaʻi ʻia ʻo CoDE-HF a loaʻa ka hoʻokae maikaʻi ʻana i nā maʻi me ka puʻuwai ʻole a me ka ʻole o ka puʻuwai (wahi ma lalo o ka pihi hoʻokipa hana 0.846 (0.830 a i 0.862) a me 0.925 (0.919 a i 0.932) a me kahi helu Brier o 0.130 a me 0.130.0.099) (Fig. 4; Fig. L).Hāʻawi kahi helu CoDE-HF o 4.7 i ka waiwai wānana maikaʻi ʻole o 98.6% (97.8% a i 99.1%) a me kahi naʻau o 98.1% (96.9% a i 98.9%) (Supplementary Table G), a ʻo ka helu o 51.2 hāʻawi i kahi wānana maikaʻi. waiwai.waiwai 75.0% (65.7%) 82.5%), kiko'ī he 92.2% (87.5% i 95.2%) o nā maʻi me ka ʻole o ka mōʻaukala o ka naʻau.ʻO kēia mau helu hoʻokomo a me ka hoʻokuʻu ʻana i like ka hana diagnostic ma nā pūʻulu āpau (Figure 5, Figure 6, Figure 7). Inā hoʻohana ʻia kēia mau helu i nā poʻe maʻi i manaʻo ʻia me ka hōʻino ʻole ʻana o ka naʻau, e ʻike ʻo CoDE-HF i ka 40.3% (2502/6208) ma kahi haʻahaʻa haʻahaʻa (<4.7) a me 28.0% (1737/6208) ma ke kūlana kiʻekiʻe (≥51.2) o hōʻeha puʻuwai ʻeha. Inā hoʻohana ʻia kēia mau helu i nā poʻe maʻi i manaʻo ʻia me ka hōʻino ʻole ʻana o ka naʻau, e ʻike ʻo CoDE-HF i ka 40.3% (2502/6208) ma kahi haʻahaʻa haʻahaʻa (<4.7) a me 28.0% (1737/6208) ma ke kūlana kiʻekiʻe (≥51.2) o hōʻeha puʻuwai ʻeha. Если бы эти показатели применялись к пациентам с подозрением на острую сердечную недостаточность, CoDE-HF выявил бы 40,3% (2502/6208) при низкой вероятности (<4,7) и 28,0% (1737/6208) при высокой вероятности (≥51,2) сердечной недостаточности. Inā hoʻohana ʻia kēia mau helu i nā poʻe maʻi i manaʻo ʻia me ka hōʻeha ʻole o ka naʻau, e ʻike ʻo CoDE-HF i ka 40.3% (2502/6208) me kahi haʻahaʻa haʻahaʻa (<4.7) a me 28.0% (1737/6208) me ka puʻuwai kiʻekiʻe (≥51.2) hāʻule.hōʻeha puʻuwai ʻeha.如果 for 评分 评分评分 应用衰竭 B衰竭 to 的 患者患者, Cocted-HF 将 28.0% (1901/6208) 急性急性1120208) 急性 急性1) 急性急性) 急性急性) 急性 心力衰竭。如果 _ 这些 评分 急性 急性衰竭 B -衰竭 -, Code-HF 识别识别 出 2825 (2505 (2505 (2505/6208) 高概率高概率81.2 ) 急性 心力 心力 急性 急性 急性 急性 急性 急性 急性 急性 急性 急性 急性 急性 急性 急性 ОИлоти олидеони пробфичонием а Моччонивтам на 51,2) острой сердечной недостаточности. Inā hoʻohana ʻia kēia mau helu i nā poʻe maʻi i manaʻo ʻia me ka hōʻeha ʻole o ka naʻau, e hōʻike ʻo CoDE-HF i ka 40.3% (2502/6208) haʻahaʻa haʻahaʻa (<4.7) a me 28.0% (1737/6208) kiʻekiʻe (≥ 51.2).paupauaho.Ma waena o nā poʻe maʻi me ka puʻuwai puʻuwai mua, ʻaʻohe o nā helu i ka cohort hoʻomaʻamaʻa i hoʻokō i kā mākou mau pae hoʻokaʻawale.ʻO ka helu CoDE-HF he 84.5, ʻo ka waiwai wānana maikaʻi ʻo 92.7% (89.1% a 95.2%), a ʻo ka kikoʻī he 90.2% (84.0% a 94.1%).E hōʻike ana kēia loiloi i ka 45.5% (1420/3119) o nā maʻi me ke kūlana kiʻekiʻe o ka ulu ʻana o ka puʻuwai puʻuwai (Fig. 8).Ma ka hoʻoholo hoʻoholo ʻana i nā ʻano like ʻole o ka paepae, ua ʻoi aku ka nui o ka loaʻa ʻana o CoDE-HF ma mua o NT-proBNP wale nō (Supplementary Figure M).Ua hōʻemi iki ʻia nā helu CoDE-HF me ka ʻole o ka mōʻaukala o ka hoʻomaʻamaʻa ʻana (ʻo 0.922 (0.916 a i 0.929) ka wahi ma lalo o ka pihi hana hoʻokipa a me 0.841 (0.825 a i 0.825 i nā maʻi me ka ʻole o ka puʻuwai a me ka naʻau mua ʻole) 0.857)).Hana maikaʻi ʻia ka hoʻopaʻa ʻana i loko a me waho i ka cohort o nā hiʻohiʻona ʻelua (Supplementary Figure N).
Ua hoʻohālikelike ʻia ka Heart Failure Joint Diagnosis and Evaluation Scale (CoDE-HF) i ka māhele ʻike ʻia o nā poʻe maʻi me ka hāʻule ʻole o ka naʻau.Hōʻike ka laina kiko i ka calibration kūpono.ʻO kēlā me kēia helu e pili ana i nā maʻi 100.Kiʻekiʻe: CoDE-HF calibration i ka mea maʻi me ka ʻole o ka naʻau mua.Ma lalo: CoDE-HF calibration i ka mea maʻi me ka mōʻaukala o ka naʻau ʻole.
ʻO ka hana diagnostic o ka Heart Failure Collaborative Diagnosis and Evaluation Scale (CoDE-HF) ma nā pūʻulu maʻi.Loaʻa i ka helu hoʻokaʻawale CoDE-HF kahi waiwai wānana maikaʻi ʻole o 4.7 i ka subgroup o nā maʻi me ka ʻole o ka moʻolelo o ka puʻuwai naʻau.Hoʻohana ʻo CoDE-HF i ka N-terminal natriuretic peptide type B precursor concentrations ma ke ʻano he ana mau a me nā ʻano hoʻololi maʻalahi maʻalahi (makahiki, manaʻo ʻia ʻo glomerular filtration rate (eGFR), hemoglobin, body mass index, heart rate, blood pressure, peripheral edema, chronic obstructive ʻO ka maʻi pulmonary (COPD) a me ka maʻi maʻi puʻuwai) hāʻawi i kahi loiloi pilikino i ka hiki ke loaʻa kahi hōʻailona o ka hāʻule ʻole o ka naʻau.
ʻO ka hana diagnostic o ka CoDE-HF scale ma ka Collaboration for the Diagnosis and Evaluation of Heart Failure scale in subgroups of maʻi.Ua loaʻa i ka helu kānāwai CoDE-HF kahi waiwai wānana maikaʻi o 51.2 i ka subgroup o nā maʻi me ka ʻole o ka moʻolelo o ka naʻau ʻole.Hoʻopili ʻo CoDE-HF i nā manaʻo koʻikoʻi NT-proBNP ma ke ʻano he ana mau a me nā ʻano hoʻololi maʻalahi maʻalahi (makahiki, manaʻo ʻia ka helu kānana glomerular (eGFR), hemoglobin, helu helu kino kino, ka puʻuwai, ke koko, ka edema peripheral, ka maʻi obstructive pulmonary maʻi (COPD) ).ʻO ka maʻi ʻaʻaʻa coronary) hāʻawi i kahi loiloi hoʻokahi i ka hiki ke loaʻa kahi hōʻailona o ka hāʻule ʻole o ka naʻau
ʻO ka hana diagnostic o ka Collaboration for Diagnosis and Evaluation of Heart Failure (CoDE-HF) scale ma nā pūʻulu maʻi.He 84.5 ka waiwai wānana maikaʻi o ka helu kānāwai CoDE-HF i nā poʻe maʻi me ka mōʻaukala o ka puʻuwai puʻuwai ma kahi pūʻulu o nā maʻi.Hoʻopili ʻo CoDE-HF i nā manaʻo koʻikoʻi NT-proBNP ma ke ʻano he ana mau a me nā ʻano hoʻololi maʻalahi maʻalahi (makahiki, manaʻo ʻia ka helu kānana glomerular (eGFR), hemoglobin, helu helu kino kino, ka puʻuwai, ke koko, ka edema peripheral, ka maʻi obstructive pulmonary maʻi (COPD) ).ʻO ka maʻi ʻaʻaʻa coronary) hāʻawi i kahi loiloi hoʻokahi i ka hiki ke loaʻa kahi hōʻailona o ka hāʻule ʻole o ka naʻau
ʻAʻole maikaʻi ka diagnostically o ka Heart Failure Joint Diagnosis and Assessment Scale (CoDE-HF) i nā poʻe maʻi me ka mōʻaukala o ka puʻuwai naʻau.Kiʻekiʻe: Nā waiwai wānana maikaʻi ʻole no nā helu CoDE-HF.Hōʻike ka laina kiko kiko polū i ka helu hoʻopau ʻana o ka 4.7.Hōʻike ka laina kiko kiko ʻulaʻula i ka helu o ka lula pahuhopu o 51.2.Ma lalo: palapala ʻāina paʻa o nā helu CoDE-HF i nā poʻe maʻi me ka ʻole o ka moʻolelo o ka hāʻule ʻole o ka naʻau.Ua ʻike ʻia nā pahuhopu hoʻokaʻawale a me nā lula i ka 40.3% o nā mea maʻi me ka haʻahaʻa haʻahaʻa a me 28.0% me ke kiʻekiʻe kiʻekiʻe.
ʻO nā poʻe maʻi i ʻike ʻia he haʻahaʻa haʻahaʻa e CoDE-HF he haʻahaʻa haʻahaʻa loa i nā kumu āpau a me ka make CV ma 30 mau lā a me 1 makahiki ma mua o nā maʻi i ʻike ʻia he waena a me ke kūlana kiʻekiʻe (30-lā mau kumu make a pau: 1. 0% i hoʻohālikelike ʻia me 4.0 % a me 10.4%).ka make mai nā kumu a pau i loko o hoʻokahi makahiki: 5.9% me 17.8% a me 33.4%;30 mau lā make mai nā maʻi cardiovascular: 0.2% vs. 0.8% a me 4.1%;ka make makahiki mai nā maʻi cardiovascular: 1.4% versus 3.4% a me 16.3%, kēlā me kēia) (Fig. 9). I nā poʻe maʻi me ka nui o ka NT-proBNP <300 pg/mL i hoʻohālikelike ʻia me kēlā ‰¥300 pg/mL, ʻo ka nui o nā kumu make a pau he 0.8% versus 7.6% i nā lā 30 a me 5.9% versus 26.6% i hoʻokahi makahiki, a. ʻO ka nui o ka make maʻi cardiovascular he 0.1% me ka 2.6% i nā lā 30 a me ka 1.3% me ka 10.2% i hoʻokahi makahiki, kēlā me kēia (papakaukau hoʻohui H; helu hoʻohui O). I nā poʻe maʻi me ka nui o ka NT-proBNP <300 pg/mL i hoʻohālikelike ʻia me kēlā ‰¥300 pg/mL, ʻo ka nui o nā kumu make a pau he 0.8% versus 7.6% i nā lā 30 a me 5.9% versus 26.6% i hoʻokahi makahiki, a. ʻO ka nui o ka make maʻi cardiovascular he 0.1% me ka 2.6% i nā lā 30 a me ka 1.3% me ka 10.2% i hoʻokahi makahiki, kēlā me kēia (papakaukau hoʻohui H; helu hoʻohui O). У паненто стонцрациче 0 08% ЛИгакнаю В 7,8% поратовиа 6% через один год, соответственно, и показатели смертности от сердечно-сосудистых заболеваний составили 0,1% по сравнению с 2,6% через 30 дней и 1,3% по сравнению с 10,2% через один год соответственно (дополнительная таблица H; дополнительный рисунок O). I nā poʻe maʻi me kahi ʻano NT-proBNP <300 pg / ml i hoʻohālikelike ʻia me ka mea ma lalo o 300 pg / ml, ʻo 0.8% ka nui o ka make i hoʻohālikelike ʻia me 7.6% i nā lā 30 a me 5.9% i hoʻohālikelike ʻia me 26, 6% i hoʻokahi makahiki. , a he 0.1% ka nui o ka make ma ka 2.6% ma 30 mau la a me 1.3% i ka 10.2% i ka makahiki hookahi, (Pākuʻi Pākuʻi H; Kiʻi Hoʻohui O). Nt-Probnp 浓度 <300 1 m tg / ML 的 和 一死亡率在30 天时分别为0.1% 和2.6%，一年时分别为1.3% 和10.2%（补充表H；图O光。 Nt-probnp 浓度 <300 pg / m kane / m? 与 ≥6. O Nā 以及 以及 以及 以及 以及 以及 以及 一 一 一 1 一 2.3> 图 图 + 补充 2.2 hEn 2 图 图 Nokia 和 2.2 H; ）. Пацинты СиеТа-Dob Mehей ViaH "тичнть Оме года, а также сердечно-сосудистую смертность. ʻO ka poʻe maʻi me ka nui o ka NT-proBNP <300 pg / mL i hoʻohālikelike ʻia me ≥300 pg / mL he 30 mau lā o ka make āpau o 0.8% a me 7.6%, kēlā me kēia, 5.9% a me 26.6% i loko o hoʻokahi makahiki, a me ka make cardiovascular.ʻO 0.1% a me 2.6% i nā lā 30 a me 1.3% a me 10.2% i ka makahiki 1 (Paʻi Hoʻohui H; Kiʻi Hoʻohui O).
Hoʻopili ʻia ka nui o nā kumu make a pau e Collaborative for the Diagnosis and Evaluation of Heart Failure (CoDE-HF) probability group
Ua hana mākou i ka meta-analysis o kēlā me kēia kanaka maʻi-level data e loiloi i ka hana diagnostic o nā paepae NT-proBNP ma mua o 10 mau mea maʻi me ka manaʻo ʻole o ka puʻuwai puʻuwai i hoʻokomo ʻia i loko o 14 mau noiʻi prospective mai nā ʻāina 13 a mākou i hoʻolālā a hoʻokō me ka hoʻohana ʻana i ka NT-proBNP.proBNP ma ke ʻano he mea kōkua hoʻoholo no ke ana mau.Hōʻike mākou i kekahi mau ʻike koʻikoʻi.ʻO ka mea mua, ʻaʻole kūlike nā paepae i ʻōlelo ʻia no ka haʻalele ʻana i ka puʻuwai koʻikoʻi ma waena o nā pūʻulu maʻi koʻikoʻi.3 ʻOiai ua hana maikaʻi ka heluna kanaka a me kekahi mau pūʻulu liʻiliʻi, me nā maʻi ʻōpio a me nā wahine, ua haʻahaʻa loa ka poʻe maʻi a me nā wahine i nā waiwai wānana maikaʻi ʻole.I nā poʻe maʻi me ka momona a i ʻole ka puʻuwai naʻau mua, ʻo ka helu ʻino ʻole mai ka ʻumi a i ka ʻelima.ʻO ka lua, ua hōʻike maikaʻi ʻia nā paepae i hoʻopaʻa ʻia i nā makahiki i ka hōʻoia ʻana o ka puʻuwai puʻuwai.Eia naʻe, ua emi ka waiwai wānana maikaʻi i nā maʻi ʻōpio.ʻO ke kolu, ʻoiai ʻo kā mākou ʻokiʻoki NT-proBNP maikaʻi loa o 100 pg/mL no ka hoʻokuʻu ʻana i ka hemahema o ka naʻau a me 1000 pg/mL no ka hoʻoponopono ʻana i ka puʻuwai puʻuwai koʻikoʻi maikaʻi loa ka waiwai wānana maikaʻi ʻole a maikaʻi i ka heluna lehulehu, ʻoi aku ka maikaʻi o nā poʻe maʻi kahiko. .i nā poʻe maʻi me ka puʻuwai koʻikoʻi.ʻO ka naʻau mua a me ka momona.ʻO ka hope, ua hoʻomohala a hōʻoia mākou i kahi hāmeʻa kākoʻo hoʻoholo, ka helu CoDE-HF, me ka hana diagnostic maikaʻi loa i nā pūʻulu maʻi āpau.Ua kāpae ʻia kēia hāmeʻa kākoʻo hoʻoholo a hoʻoholo i ka hōʻino ʻana o ka naʻau ma mua o ke ʻano o ka hoʻohana ʻana i ka paepae NT-proBNP wale nō.
I ko mākou ʻike, ʻo kēia ka haʻawina nui loa a hiki i ka loiloi ʻana i ka hana diagnostic o NT-proBNP i ka hāʻule ʻole o ka naʻau.ʻO nā haʻawina āpau i hoʻopili ʻia he mau hope a ua hana ʻia nā diagnoses hope e kahi papa o nā kauka e hoʻohana ana i nā ʻike āpau i loaʻa.He mea nui e hoʻomaopopo i ka loaʻa ʻana o ka ʻikepili i kēlā me kēia pae maʻi i nā heluna aʻo nui e hiki ai i ka loiloi hilinaʻi o ka hana diagnostic o nā paepae NT-proBNP hiki i nā subgroups o nā mea maʻi, a me ka hoʻomohala ʻana a me ka hōʻoia ʻana i nā unahi diagnostic hou.
ʻO ka hapa nui o nā alakaʻi aupuni a me ka honua e paipai i ka hoʻohana ʻana i kahi waiwai oki ʻia NT-proBNP o 300 pg/mL no ka hoʻokuʻu ʻana i ka pau ʻole o ka naʻau58 ma muli o nā haʻawina mua he nui344142 e hōʻike ana i kahi waiwai wānana maikaʻi ʻole o 98% ma kēia ʻoki.ʻAʻole hiki ke loiloi ʻia ka hana diagnostic o nā pūʻulu koʻikoʻi o nā maʻi.Ua hoʻopaʻa inoa ʻia kā mākou haʻawina i ʻekolu mau manawa i ka nui o nā maʻi e like me nā meta-analyses pae haʻawina mua, 3 i hōʻike i ka haʻahaʻa haʻahaʻa haʻahaʻa haʻahaʻa haʻahaʻa haʻahaʻa ma kahi ʻoki ʻia o 300 pg/mL me ka pooled meta-estimation o 94.6%.ʻO ka mea nui, ʻoi aku ka haʻahaʻa o ka waiwai wānana maikaʻi ʻole i nā pūʻulu koʻikoʻi e like me nā poʻe maʻi ʻelemakule a me nā mea maʻi me ka puʻuwai mua o ka naʻau, ka maʻi coronary artery, a me ka momona.Eia kekahi, kokoke i ka 70% o nā mea maʻi i loaʻa nā manaʻo NT-proBNP ma luna o ka 300 pg / ml ʻoki ʻoki, e hōʻike ana i nā palena o ka hoʻohana ʻana i kahi ʻoki ʻoki hoʻokahi i ka hana.ʻOiai ua loaʻa i ka ʻoki haʻahaʻa o 100 pg/mL i kahi waiwai wānana maikaʻi ʻole holoʻokoʻa o 98%, ua hana maikaʻi ʻole ia i kahi pūʻulu koʻikoʻi o nā maʻi.Eia kekahi, ʻo ka makahiki a me nā paepae i hoʻopaʻa ʻia no ka hōʻino ʻana o ka naʻau i hōʻike ʻia i ka heterogeneity ma waena o nā pūʻulu maʻi, ʻoi aku hoʻi i waena o ka poʻe me ka moʻolelo mua ʻole o ka puʻuwai naʻau.ʻO kēia heterogeneity i ka hana diagnostic he mea hopohopo koʻikoʻi e like me ka nui o ko mākou poʻe maʻi a ʻoi aku ka nui o nā comorbidities.Hoʻoulu kēia i ka nīnau inā pono e hoʻomau nā alakaʻi lapaʻau i ka hoʻohana ʻana i nā ʻoki ʻoki like ʻole i ka wā e hoʻopilikia ʻia ai ka NT-proBNP e nā kumu pilikia a me nā comorbidities.
No ka hoʻomaikaʻi ʻana i ka pono lapaʻau o NT-proBNP, ua kūkulu mākou a hōʻoia i waho i ka loiloi CoDE-HF o kahi hāmeʻa kākoʻo hoʻoholo.Hoʻohui kēia helu i ka NT-proBNP ma ke ʻano he ana hoʻomau me nā ʻano hoʻololi maʻalahi o ka maʻi e hāʻawi i kahi loiloi pilikino i ka hiki ke loaʻa kahi hōʻailona o ka hāʻule ʻole o ka naʻau.Hōʻike mākou he ikaika ka hana diagnostic o ka helu CoDE-HF i nā pūʻulu o nā maʻi.Ua hiki iā CoDE-HF ke hoʻokuʻu a hoʻokuʻu i ka hōʻailona o ka puʻuwai puʻuwai ma kahi hapa nui o nā maʻi ma mua o ka paepae NT-proBNP i hoʻopaʻa ʻia.Eia kekahi, i kā mākou hoʻoholo hoʻoholo ʻana, ua ʻike mākou he ʻoi aku ka maikaʻi o ka ʻupena ʻo CoDE-HF ma mua o NT-proBNP wale nō, ma ka pae holoʻokoʻa o ka paepae.Manaʻo mākou he intuitive kēia hopena no ka mea ʻo NT-proBNP kahi hōʻailona hoʻomau o ka pilikia a hilinaʻi kona manaʻo i nā mea e pili ana i ka maʻi e like me ka helu kino kino, ka makahiki, a me ka hana renal.434445 ʻOiai ua hoʻokumu ʻia kēia mau lakio ma luna o nā pae hoʻokō i koho mua ʻia, ʻike mākou ʻaʻole i kākoʻo ʻia kēia mau pahuhopu i ke ao holoʻokoʻa a loaʻa paha i nā hale mālama ola kino ʻokoʻa nā hoʻomanawanui pilikia.ʻO ka maikaʻi o ka hoʻohana ʻana i nā mea hana kākoʻo hoʻoholo e like me CoDE-HF ʻo ia ka hiki i nā kauka a i ʻole nā ​​​​hui ke koho i nā pae hoʻokō diagnostic e hoʻohana ʻia no ka hoʻoholo kūloko ma muli o kā lākou mau mea nui a me ka loaʻa ʻana o ka echocardiography a i ʻole nā ​​​​poʻe loea puʻuwai..
Manaʻo mākou e hiki i kā mākou mea hana hoʻoholo hoʻoholo hou, Code-HF, ke hoʻomaikaʻi i ka hoʻāʻo ʻana o nā poʻe maʻi i manaʻo ʻia i ka hōʻeha ʻole o ka naʻau i ʻike ʻia ma nā ʻano loea lapaʻau like ʻole a hoʻololi i kā lākou mālama, e hoʻomaʻamaʻa i ka hōʻoia pololei.Ua hōʻike ʻia nā haʻawina mua e hiki i ka mālama ʻana i ka manawa kūpono a me ka pololei o nā maʻi me ka puʻuwai puʻuwai ke hōʻemi nui i ka make a me ka lōʻihi o ka noho ʻana i ka haukapila, a pili pū ka lohi me nā hopena ʻino.46 Eia hou, hoʻohana ʻo CoDE-HF i hōʻiliʻili mau ʻia i nā ʻano like ʻole a no laila hiki ke hoʻohui ʻia i loko o nā kaʻina hana lapaʻau ma ke ʻano he ʻāpana o ke ala hoʻāʻo o ke keʻena pilikia e hiki ai i ka loiloi ʻoi aku ka maikaʻi.I kēia manawa, ʻo ka hapa nui o nā poʻe maʻi i manaʻo ʻia me ka hōʻino ʻole ʻana o ka naʻau he echocardiography ma ke komo ʻana e hoʻoholo ai i kā lākou mālama ʻana, akā ʻo kahi hapa o nā maʻi i ʻike hope ʻia.2 ʻO ka Echocardiography kahi haʻawina kūikawā hoʻopau manawa a me nā kumu waiwai Manaʻo mākou ʻo ka hoʻohana ʻana o CoDE-HF no ka hoʻohana ʻana i nā lawelawe kūikawā e like me ka echocardiography hiki ke alakaʻi i ka mālama kālā nui a me ka maikaʻi no ka ʻōnaehana olakino..Eia kekahi, hiki ke hoʻokō ʻia ke kumukūʻai ma o ka mālama ʻana i nā maʻi maʻi haʻahaʻa.Pono e noiʻi ʻia i kēia manawa no ka loiloi ʻana i ka lāʻau lapaʻau a me ka maikaʻi o ke kumukūʻai o nā pae hoʻoholo CoDE-HF like ʻole i ka hana lapaʻau.
Hoʻomaopopo mākou i kekahi mau palena.ʻO ka mea mua, ua hiki iā mākou ke loaʻa i ka ʻikepili maʻi hoʻokahi no ka 14 o nā haʻawina 30 i hoʻokō i kā mākou mau pono kūpono, no laila hiki ke hoʻokomo ʻia ke koho koho.Eia nō naʻe, ʻo nā haʻawina kūpono ʻaʻole i hoʻokomo ʻia, ua like ka laha o ka puʻuwai puʻuwai, nā lā hoʻopuka, a me ka uhi ʻāina, a ua like nā ʻano demographic a me nā ʻano lapaʻau i nā heluna kanaka.ʻO ka lua, i ka wā i hui ʻia ai ka ʻike mai nā haʻawina he nui, ua nalowale kekahi mau haʻawina no kekahi mau ʻano.No ka hoʻonui ʻana i ka hoʻohana ʻana i ka ʻike, ua hoʻohana mākou i kahi ala hierarchical o ka nui imputation.ʻO ke kolu, ʻaʻole mākou i hoʻopaʻa i ka ʻikepili ECG a me ka umauma X-ray e hoʻokomo iā lākou i kā mākou kumu hoʻohālike.ʻO ka wehewehe ʻana i ka NT-proBNP i nā poʻe maʻi i manaʻo ʻia me ka puʻuwai puʻuwai i manaʻo ʻia e hana pū me kēia mau haʻawina, 47 a pono nā noiʻi hou aʻe e hoʻoholo ai inā hiki ke hoʻomaikaʻi i nā helu CoDE-HF nā ala e hui pū ai i kēia mau haʻawina.ʻO ka hā, ʻaʻole nā ​​​​haʻawina āpau i hana i nā diagnoses me ka ʻole e noʻonoʻo i nā hopena o ka hoʻāʻo NT-proBNP.I loko o kā mākou ʻike loiloi, i ka wā i haʻalele ai mākou i ʻelua mau haʻawina me ka wehewehe ʻole ʻia, ʻaʻohe loli i ka hana diagnostic.ʻO ka lima, ʻaʻole i ʻae ʻia ka hoʻopaʻa ʻia ʻana o ka hōʻeha puʻuwai puʻuwai i ka ʻokoʻa ma waena o ka pau ʻole o ka naʻau me ka haʻihaʻi ejection i hoʻemi ʻia a me ka pau ʻole o ka naʻau me ka ʻāpana ejection i mālama ʻia.48 Hiki ke wehewehe i ka nui o ka HF me ka hakina ejection i mālama ʻia i nā poʻe maʻi ʻelemakule i kekahi o ka heterogeneity i ʻike ʻia me ka makahiki, akā ʻōlelo nā alakaʻi o kēia manawa i ka HF me ka haʻihaʻi ejection i hōʻemi ʻia a mālama ʻia ʻo EF.Hoʻohana ka puʻuwai i ka paepae NT-ProBNP like.58 ʻO ke ono, ʻoiai ʻo ka hapa nui o nā haʻawina i hoʻopaʻa inoa mau i nā poʻe maʻi me ka dyspnoea koʻikoʻi, ua kiʻekiʻe ka prevalence o ka puʻuwai puʻuwai kiʻekiʻe a ua loaʻa paha ke koho koho.Eia nō naʻe, ʻaʻole i loli ka maikaʻi o nā alakaʻi i ʻoki ʻia NT-proBNP a me nā palena makahiki i ka nānā ʻana i ka naʻau, koe wale nō nā haʻawina me ka nui o ka pilikia.ʻO ka mea hope loa, ʻo ka hōʻino ʻana o ka naʻau he maʻi maʻi maʻi, a ʻo ka maʻi maʻi ponoʻī he ʻano kānalua ʻole a me ka loli noiʻi.ʻOi aku paha kēia kānalua i ka poʻe ʻelemakule, kahi e wehewehe ai i ka heterogeneity i ʻike ʻia i nā hopena diagnostic.
Ua hōʻike mākou i ka hana diagnostic o nā waiwai ʻokiʻoki NT-proBNP i ʻōlelo ʻia i nā alakaʻi no ka puʻuwai puʻuwai ʻokoʻa ma waena o kahi pūʻulu koʻikoʻi o nā maʻi.Ua hoʻomohala a hōʻoia mākou i ka helu CoDE-HF, kahi e hui pū ai i ka NT-pro-BNP ma ke ʻano he ana mau me nā ʻano hoʻololi lāʻau lapaʻau e hoʻoholo ai i ka hiki ʻana o ka puʻuwai koʻikoʻi i nā poʻe maʻi me ka hoʻohana ʻana i ke ʻano helu helu.Hoʻopau pololei ʻia kēia mea kākoʻo hoʻoholo a kāpae ʻia i ka hōʻino ʻole o ka naʻau a ua hana mau ʻia ma nā pūʻulu āpau.Pono nā haʻawina hoʻolālā i kēia manawa e loiloi i ka hopena o ka hoʻokō ʻana i kēia hāmeʻa kākoʻo hoʻoholo i ka hoʻohana ʻana i nā kumuwaiwai olakino a me nā hopena maʻi.
Hiki ke paʻakikī ka hōʻoia ʻana o ka puʻuwai puʻuwai no ka mea pinepine nā maʻi me nā hōʻailona kikoʻī ʻole.
Manaʻo ka hapa nui o nā alakaʻi aupuni a me ka honua i ka hoʻāʻo ʻana i ka N-terminal B-type natriuretic peptide precursor (NT-proBNP) no ka hōʻoia ʻana o ka hōʻeha puʻuwai.
ʻAʻole i hoʻohana ʻia ka hoʻāʻo NT-proBNP ma muli o nā pilikia me ka hana diagnostic i nā pūʻulu koʻikoʻi koʻikoʻi o nā maʻi.
ʻO nā paepae NT-proBNP i ʻōlelo ʻia no ka hāʻule ʻole o ka naʻau i loko o nā alakaʻi he maikaʻi ʻole ka hana diagnostic i nā pūʻulu maʻi koʻikoʻi.
Ua hoʻomohala ʻia kahi hāmeʻa kākoʻo hoʻoholo i hoʻopaʻa ʻia e hoʻohui i ka NT-pro-BNP ma ke ʻano he ana mau me nā ʻano lāʻau lapaʻau e hoʻohana ana i ka hoʻohālike helu.
ʻOi aku ka pololei o kēia mea hana a hoʻoholo i ka hōʻeha puʻuwai koʻikoʻi ma mua o ke ʻano o ka hoʻohana ʻana i ka paepae NT-proBNP wale nō a ua hana mau ʻia ma nā pūʻulu āpau.
Ua mālama ʻia nā haʻawina a pau e like me ka Hōʻike o Helsinki a ua ʻae ʻia e kaʻana like i ka ʻikepili pae maʻi no kēia loiloi.
Loaʻa ka helu R a me ka ʻikepili inoa ʻole i hoʻohana ʻia e hoʻomohala a hōʻoia i ka helu CoDE-HF i nā mea noiʻi ma ke noi a ka mea kākau.