N-terminal proBNP for Inpatients and ED Patients


Abbrev Code:NTBNPI   
Order Code:LAB106Order Name:NT PROBNP Inpatient
Synonyms:NT-proBNP; Brain natriuretic peptide
Methodology:Roche: Sandwich immunoassay
Vista/Remisol: Chemiluminescense
CPT Codes: 83880 x1, 83880 x1
Turnaround Time:Performed and reported 24 hours/day.


Collection Instructions

Specimen:Blood
Optimal Volume:2.5 mL
Minimum\Peds Volume:0.6 mL
Collection Instructions:Chemistry Tests Containers Chart
Causes for Rejection:Hemolyzed samples.
Contraindications:Large doses of biotin (10 mg or more per day) may cause clinically significant interference in N-Terminal pro brain natriuretic peptide levels. If interference is suspected, it is strongly recommended that biotin is discontinued for at least one week prior to retesting.


Processing and Shipping

Specimen Processing:Centrifuge and aliquot 1.25 mL, 0.2 mL minimum. Store in refrigerator.
Shipping Instructions:Ship at refrigerated temperature to arrive within 72 hours. Alternatively, ship on dry ice.
Stability:3 days at room temperature; 6 days refrigerated; 2 years frozen
Test Performed at or Referral Lab Chemistry  (Grand Itasca, Northland, Range, Roche-CSC Mpls, Roche-Lakes, Roche-Ridges, Roche-St. John's, Roche-UMMC East, Southdale, UMMC/UMMCH-West Bank)


Interpretive

Reference Range:GH Remisol: All ages: 0-100 pg/mL
Age Vista
pg/mL
Age Roche
pg/mL
0-2 d 0-13,000    0-2 d 0-13,000  
3-30 d 0-6,500 3-30 d 0-6,500
1-12 mo 0-1000 1-12 mo 0-1,000
1 y 0-680 1 y 0-680
2-5 y 0-330 2-5 y 0-330
6-17 y 0-240 6-17 y 0-240
18-49 y 0-450 18-74 y 0-450
50-75 y 0-900 50-75 y   0-900
76 y & older    0-1,800 76 y & older   0-1800

Guidelines:
  • Establishing a baseline value for each individual patient is useful for future follow-up.
  • Suggested inpatient cut points for confirming the diagnosis of CHF
Inpatient (acute) Cut Points (pg/mL)
18-49 y Greater than 450
50-75 y Greater than 900
76 y & older Greater than 1800
  • An inpatient or emergency department patient NT-pro-BNP of less than 300 pg/mL effectively rules out acute congestive heart failure. 
 
Use:B-Type Natriuretic Peptide (BNP) protein is classed as a cardiac neurohormone and originates from the myocytes of the atrium and ventricles of the heart. It is secreted under conditions of myocardial stretching, volume overload, and increased ventricular filling pressures. ProBNP, the immediate precursor of BNP cleaves to form BNP and NT-proBNP in a 1:1 ratio. NT-proBNP concentrations are higher because the half-life is one to two hours, compared to 22 minutes for BNP. NT-proBNP is used to differentiate heart failure from pulmonary disease in patient presenting with symptoms of dyspnea and shortness of breath. Marked elevations of NT-proBNP may be observed in states other than left ventricular congestive heart failure, including: acute coronary syndromes, right heart strain/failure (including pulmonary embolism and cor pulmonale), critical illness, renal failure, as well as advanced age. Falsely low NT-proBNP in congestive heart failure patients may be observed with increasing body mass index.


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