Clinical Laboratory in Emergency Medicine| Volume 41, ISSUE 6, P661-667, December 2011

Comparison of the Diagnostic Characteristics of Two B-Type Natriuretic Peptide Point-of-Care Devices



      B-type natriuretic peptide (BNP) is used to diagnose heart failure (HF).


      To compare the accuracy of two commercially available point-of-care (POC) devices for measuring B-type natriuretic peptide (BNP) in emergency department (ED) patients with suspected heart failure using the central laboratory testing results as the criterion standard.


      Venous blood samples were collected from adults with suspected heart failure and split into three samples for BNP analysis: central laboratory (Siemens ADIVA Centaur; Siemens, Deerfield, IL), Triage BNP POC device (Biosite, San Diego, CA), and i-STAT BNP POC device (Abbott, East Windsor, NJ). The criterion standard for BNP levels was the central laboratory.


      Two hundred fifty patients were enrolled. Mean (SD) age was 70.7 (13.8) years; 200 (80%) were over age 55 years; 146 (58.4%) were male. A final hospital discharge diagnosis of heart failure was made in 108 (42%) patients. The i-STAT system yielded a result within a median of 9 min (interquartile range [IQR] 9–10 min). The Triage device yielded a result within a median of 19 min (IQR 15–22 min); p < 0.001. The device failure rate for the central laboratory (8 failures, 3.2%) was significantly higher than that of the i-STAT device (1 failure, 0.4%, p = 0.04), but not statistically different than the Triage device (3 failures, 1.2%). Neither the Triage nor the i-STAT were statistically different than the central laboratory result in terms of sensitivity; the i-STAT was less specific than the Triage result (p = 0.003). The area under the curve for the Triage device was 0.95 (95% confidence interval [CI] 0.91–0.98), whereas the area under the curve for the i-STAT device was 0.98 (95% CI 0.96–0.99; p < 0.01).


      Both POC devices tested were accurate and rarely failed; however, the i-STAT was faster with single use.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Lloyd-Jones D.
        • Adams R.
        • Carnethon M.
        • et al.
        Heart disease and stroke statistics 2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.
        Circulation. 2009; 119: e101-e104
        • Jessup M.
        • Brozena S.
        Heart failure.
        N Engl J Med. 2003; 348: 2007-2018
        • Peacock W.F.
        • Emerman C.
        • Costanzo M.R.
        • Diercks D.B.
        • Lopatin M.
        • Fonarow G.C.
        Early vasoactive drugs improve heart failure outcomes.
        Congest Heart Fail. 2009; 15: 256-264
        • Morrow D.A.
        • de Lemos J.A.
        Benchmarks for the assessment of novel cardiovascular biomarkers.
        Circulation. 2007; 115: 949-952
        • Braunwald E.
        Biomarkers in heart failure.
        N Engl J Med. 2008; 358: 2148-2159
        • Daniels L.B.
        • Maisel A.S.
        Natriuretic peptides.
        J Am Coll Cardiol. 2007; 50: 2357-2368
        • Maisel A.S.
        • Clopton P.
        • Krishnaswamy P.
        • et al.
        Impact of age, race, and sex on the ability of B-type natriuretic peptide to aid in the emergency diagnosis of heart failure: results from the Breathing Not Properly (BNP) multinational study.
        Am Heart J. 2004; 147: 1078-1084
        • Maisel A.S.
        • Krishnaswamy P.
        • Nowak R.M.
        • et al.
        Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure.
        N Engl J Med. 2002; 347: 161-167
        • Howie J.N.
        • Caldwell M.A.
        • Dracup K.
        The measurement of brain natriuretic peptide in heart failure. Precision, accuracy, and implications for practice.
        AACN Clin Issues. 2003; 14: 520-531
        • Del Ry S.
        • Giannessi D.
        • Clerico A.
        Plasma brain natriuretic peptide measured by fully automated immunoassay and by immunoradiometric assay compared.
        Clin Chem Lab Med. 2001; 39: 446-450
        • Maisel A.
        • Koon J.
        • Krishnaswamy P.
        • et al.
        Utility of B-natriuretic peptide as a rapid, point of care test for screening patients undergoing echocardiography to determine left ventricular dysfunction.
        Am Heart J. 2001; 141: 367-374
        • Aspromonte N.
        • Feola M.
        • Scardovi A.B.
        • et al.
        Early diagnosis of congestive heart failure: clinical utility of B-type natriuretic peptide testing associated with Doppler echocardiography.
        J Cardiovasc Med (Hagerstown). 2006; 7: 406-413
      1. Valentine S, Chohan J, Singer AJ. Comparison of two cardiac point-of-care devices in the ED. Presented at the 2008 Emergency Nursing Association Conference, Minneapolis, MN, September 2008.

        • Lokuge A.
        • Lam L.
        • Cameron P.
        • et al.
        B-type natriuretic peptide testing and the accuracy of heart failure diagnosis in the emergency department.
        Circ Heart Fail. 2010; 3: 104-110