Is mid-regional pro-atrial natriuretic peptide (MRproANP) an accurate marker of bacteremia in pyelonephritis?

INTRODUCTION: Mid-regional pro-atrial natriuretic peptide (MRproANP) increases during systemic infections and could possibly correlate with bacteremia. METHODS: We determined the characteristics of MRproANP for accuracy to detect positive blood culture. RESULTS: Bacteremia was positive in 58 (15%) of 347 patients. MRproANP levels increased in patients with bacteremia (98.4 pmol/L [interquartile range (IQR) 68.2-153.1] vs. 66.4 pmol/L [IQR 51.0-90.3], p <0.01). Performance of MRproANP to predict bacteremia [AUC = 0.69, 95%CI: 0.61-0.77] was equivalent to C-reactive protein (0.66 [95%CI: 0.59-0.74], p = 0.53) but less accurate than procalcitonin (0.78 [95%CI: 0.72-0.84], p <0.001). CONCLUSION: Although MRproANP increased in bacteremic patients with acute pyelonephritis, results of likelihood ratios discarded its use at bedside to predict bacteremia.

Comparison of the use of conventional and prewired electrodes for electrocardiography in an emergency setting: the spaghetti study.

STUDY OBJECTIVE: We compare the quality of ECG recordings obtained with conventional and prewired electrodes in an emergency setting. METHODS: This was a prospective, randomized, open comparison study in an emergency medical services setting. Participants were patients undergoing ECG between April and May 2007 (n=105). Two 12-lead ECG recordings were made in random order with conventional and prewired electrodes. Artifacts, ie, signal noise (>0.4 seconds of recording affected) and baseline instability (>1-mV variation), were analyzed and scored by 3 blinded reviewers. Results were expressed as number of affected leads, score/lead (0 to 3 scale for signal noise; 0 to 4 scale for baseline instability), and number of leads that were totally artifact free. Time to make recordings was measured. RESULTS: Recordings were nearly as easy and took 20% less time with prewired than with conventional electrodes (118 [interquartile ratio (IQR) 90 to 150] versus 144 [IQR 120 to 182]). With prewired electrodes, fewer leads were affected by noise (1 [IQR 0 to 3] versus 3 [IQR 0 to 6]) and baseline instability (0 [IQR 0 to 2] versus 2 [IQR 0 to 4]). The mean score/lead was lower for both noise (1 [IQR 0 to 3] versus 3 [IQR 0 to 8]) and instability (0 [IQR 0 to 2] versus 2 [IQR 0 to 5]); the number of artifact-free leads was greater (38 [36%] versus 19 [18%]). There was no significant difference between electrode types in the prevalence of P-wave and QRS complex abnormalities. CONCLUSION: Recordings with prewired electrodes took significantly less time. Signal noise and baseline instability were significantly reduced. The time saved was not at the expense of the quality of the recording.

Twelve months of routine HIV screening in 6 emergency departments in the Paris area: results from the ANRS URDEP study.

OBJECTIVE: In October 2009 the French National Authority for Health recommended that HIV testing be proposed at least once to all persons aged 15 to 70 years in all healthcare settings. We examined whether routine HIV screening with a rapid test in emergency departments (EDs) was feasible without dedicated staff, and whether newly diagnosed persons could be linked to care. METHODS: This one-year study started in December 2009 in 6 EDs in the Paris area, using the INSTI™ test. Eligible individuals were persons 18 to 70 years old who did not present for a vital emergency, for blood or sexual HIV exposure, or for HIV screening. Written informed consent was required. RESULTS: Among 183 957 eligible persons, 11 401 were offered HIV testing (6.2%), of whom 7936 accepted (69.6%) and 7215 (90.9%) were tested (overall screening rate 3.9%); 1857 non eligible persons were also tested. Fifty-five new diagnoses of HIV infection were confirmed by Western blot (0.61% (95% CI 0.46-0.79). There was one false-positive rapid test result. Among the newly diagnosed persons, 48 (87%) were linked to care, of whom 36 were not lost to follow-up at month 6 (75%); median CD4 cell count was 241/mm(3) (IQR: 52-423/mm(3)). CONCLUSIONS: Screening rates were similar to those reported in opt-in studies with no dedicated staff. The rate of new diagnoses was similar to that observed in free anonymous test centres in the Paris area, and well above the prevalence (0.1%) at which testing has been shown to be cost-effective.

Accuracy of C-reactive protein, procalcitonin, and mid-regional pro-atrial natriuretic peptide to guide site of care of community-acquired pneumonia.

BACKGROUND: The use at bedside of C-reactive protein (CRP), procalcitonin (PCT) or mid-regional pro-atrial natriuretic peptide (ANP) has been advocated to help management of patients with community-acquired pneumonia (CAP) in emergency medicine. OBJECTIVE: To assess the effectiveness of CRP, PCT, and ANP measures in assisting emergency physicians deciding hospital admission for CAP with low risk of complication. DESIGN: Multicenter, prospective, observational study with blind evaluation. SETTING: Emergency departments of 12 French hospitals. PATIENTS: Five hundred forty-nine consecutive, immunocompetent adult patients with mild CAP. MEASUREMENTS: Centralized and blind measure of baseline CRP, PCT, and ANP; sensitivity, specificity, and positive and negative likelihood ratios for determining hospital admission. Gold standard for admission was defined by experts' advice combined with admission requirement or death at 28 days. Optimal threshold values were determined by receiver operating characteristic (ROC) curves, and area under curve (AUC) of the three biomarkers was compared. RESULTS: According to gold standard, 310 (56%) patients required admission and 239 (44%) needed to be discharged. PCT and ANP levels increased with Pneumonia Severity Index risk categories. ANP (AUC 0.76 [95% CI 0.72-0.80]) more accurately predicted admission requirement than did PCT (AUC 0.65 [95% CI 0.61-0.70]) or CRP (AUC 0.59 [95% CI 0.54-0.64]) (both p values <0.01). We determined that 135 pmol/L was a threshold for ANP level to discriminate admission requirement (positive likelihood ratio 7.45 [95% CI 4.22-8.16]). CONCLUSIONS: In a selected population of CAP with low risk of complication, a single ANP measurement was more accurate than CRP and PCT to predict appropriate admission. These results should be confirmed by additional studies.