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，且不易普及。尿液生物标志物可作为辅助检测手段。
目的：系统评价尿液N末端B型利钠肽原（NT-proBNP）对早产儿血流动力学显著性动脉导管未闭的诊断准确性。
方法：纳入以超声心动图为参照标准，评估血流动力学显著性动脉导管未闭早产儿的尿液NT-proBNP及尿液NT-proBNP/肌酐比值（指标检测）的相关研究。分别采用诊断准确性研究质量评价工具（QUADAS-2）与推荐等级评估、制定与评价（GRADE）工具，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程度的灵敏度与特异度，其诊断准确性会因检测方法及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。