Supplementary Material for: Diagnostic accuracy of urinary NT-proBNP for hemodynamically significant PDA in preterm infants

BACKGROUND: Echocardiography is the gold standard for the diagnosis hemodynamically significant-patent ductus arteriosus (hs-PDA). It requires trained personnel, and is not readily available. Urinary biomarkers can be used as an adjunct. OBJECTIVE: To systematically review the diagnostic accuracy of urinary NT-proBNP for hsPDA in preterm neonates. METHODS: We included studies that evaluated urinary NT-proBNP and urinary NT-proBNP/Creatinine ratio (index tests) in preterm neonates with hsPDA (participants) in comparison with echocardiogram (reference standard). Methodological quality and certainty of evidence were assessed using Quality Assessment of Diagnostic-Accuracy Studies (QUADAS-2) and Grading of Recommendations Assessment, Development and Evaluation (GRADE), respectively. RESULTS: Low quality of evidence suggests that Urinary NT-proBNP has modest sensitivity and specificity for the diagnosis of a hsPDA, with variation in accuracy based on assay and patient characteristics. CONCLUSION: Urinary NT-proBNP assays must be locally validated for specific patient populations and further studies to support its use must be performed.

背景：超声心动图（Echocardiography）是诊断血流动力学显著性动脉导管未闭（hemodynamically significant-patent ductus arteriosus, hs-PDA）的金标准。该检查依赖经过专业培训的人员，且难以广泛获取与开展。尿液生物标志物可作为其辅助检测手段。
目的：系统评价尿液N末端B型利钠肽原（NT-proBNP）对早产新生儿血流动力学显著性动脉导管未闭的诊断准确性。
方法：本研究纳入以超声心动图为金标准（reference standard），评估早产新生儿（研究对象）合并血流动力学显著性动脉导管未闭时的尿液NT-proBNP及尿液NT-proBNP/肌酐比值（urinary NT-proBNP/Creatinine ratio，指标检测）的相关研究。分别采用诊断准确性研究质量评价量表（Quality Assessment of Diagnostic-Accuracy Studies, QUADAS-2）与推荐分级、评估、制定与评价指南（Grading of Recommendations Assessment, Development and Evaluation, GRADE）对研究的方法学质量及证据确定性进行评价。
结果：低质量证据显示，尿液NT-proBNP对血流动力学显著性动脉导管未闭的诊断具有中等灵敏度与特异度，其诊断准确性随检测方法与患者特征的不同而存在差异。
结论：尿液NT-proBNP检测需针对特定患者人群进行本土化验证，且需开展进一步研究以支持其临床应用。