Multimarker strategy for risk prediction in patients presenting with acute dyspnea to the emergency department

Int J Cardiol. 2008 May 7;126(1):73-8. doi: 10.1016/j.ijcard.2007.03.119. Epub 2007 May 3.


Background: Multimarker approaches improve risk prediction in patients presenting with acute coronary syndrome. We hypothesized that simultaneous assessment of B-type natriuretic peptide (BNP), cardiac troponin I (cTNI) and C-reactive protein (CRP) enables clinicians to better predict risk among patients with acute dyspnea presenting to the emergency department.

Methods and results: In this post-hoc analysis of the B-Type natriuretic peptide for Acute Shortness of Breath Evaluation (BASEL) study, above biomarkers were available in 305 patients. Death occurred in 123 (40%) patients within 24 months of follow-up. Using prospectively defined cut-off points (BNP>100 pg/mL; cTNI>0.8 microg/L; CRP>5 mg/L) and categorizing patients by the number of elevated cardiac biomarkers, the 24 months risk of death increased in proportion to the number of cardiac biomarkers elevated (p<0.001 for trend). Elevated biomarkers significantly predicted increased risk of death at 24 months of follow-up in univariate Cox models (BNP: RR 4.78, 95%CI: 2.51-9.14; p<0.001; cTNI: RR: 2.29, 95%CI: 1.61-3.26, p<0.001; CRP: RR 1.98, 95%CI: 1.28-3.08; p=0.002). Multivariable Cox regression analysis revealed that elevated levels of BNP (p<0.001) and TNI levels (p<0.002) indicated increased risk of death during long-term follow-up, while only a statistical trend was seen for elevated CRP (p=0.09). Comparably, risk of death or rehospitalization significantly increased with the number of elevated biomarkers.

Conclusions: Our findings suggest that a simple multimarker approach with simultaneous assessment of BNP, and cTNI demonstrates potential to assist clinicians in predicting risk of death and/or rehospitalization in patients presenting with acute dyspnea in the emergency department.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers / blood*
  • C-Reactive Protein / metabolism
  • Diagnosis, Differential
  • Dyspnea / blood*
  • Dyspnea / diagnosis*
  • Dyspnea / mortality
  • Emergency Service, Hospital*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood
  • Predictive Value of Tests
  • Prospective Studies
  • Risk Factors
  • Single-Blind Method
  • Troponin I / blood


  • Biomarkers
  • Troponin I
  • Natriuretic Peptide, Brain
  • C-Reactive Protein