Comparison of pleural N‐terminal pro‐B‐type natriuretic peptide, midregion pro‐atrial natriuretic peptide and mid‐region pro‐adrenomedullin for the diagnosis of pleural effusions associated with cardiac failure

Abstract

MR-proANP is as valuable a diagnostic tool as NT-proBNP for diagnosing or excluding HF as the cause of pleural effusion.

Year in review 2013: Lung cancer, respiratory infections, tuberculosis, cystic fibrosis, pleural diseases, bronchoscopic intervention and imaging

“…76 Recently, the levels of another natriuretic peptide, the mid-region pro-atrial natriuretic peptide, were measured in the pleural fluid of 95 patients with heart failure and 90 with non-cardiac effusions, and compared with those of NT-proBNP. 77 Pleural NT-proBNP and mid-region pro-atrial natriuretic peptide had similar operating characteristics for the diagnosis of heart failure-related effusions, with respective area under curve of 0.935 and 0.918. 77 The optimal cut-off values for NT-proBNP (1700 pg/mL) and mid-region pro-atrial natriuretic peptide (260 pmol/L) were influenced by age, renal function and body mass index.…”

“…77 Pleural NT-proBNP and mid-region pro-atrial natriuretic peptide had similar operating characteristics for the diagnosis of heart failure-related effusions, with respective area under curve of 0.935 and 0.918. 77 The optimal cut-off values for NT-proBNP (1700 pg/mL) and mid-region pro-atrial natriuretic peptide (260 pmol/L) were influenced by age, renal function and body mass index. Pleural fluid levels above these cutoffs argued for heart failure (likelihood ratio positive >5), while levels below significantly decreased the probability of having cardiac effusions (respective likelihood ratio negative of 0.10 and 0.19).…”

“…Finally, NT-proBNP and mid-region pro-atrial natriuretic peptide correctly identified 83% and 69% of 29 cardiac effusions misclassified as exudates by Light’s criteria, respectively. 77 In summary, if clinicians choose pleural fluid specimens for natriuretic peptide testing, it is recommended that NT-proBNP be selected based on supporting evidence and technical reasons.…”

Diagnostic value of suPAR in differentiating noncardiac pleural effusions from cardiac pleural effusions

“…Although the Light's criteria have a high sensitivity for exudates, its sensitivity is lower in identifying transudates (1). Therefore a number of markers have been tested in effusions related to CF (12,13). Particularly a NTproBNP value higher than 1500 pg/mL is considered in favor of HF and has a high NPV value for the exclusion of the noncardiac effusions (1).…”

Identifying transudates misclassified by Lightʼs criteria

“…One paradigmatic example is the natriuretic peptide NT-proBNP, a well recognized marker of heart failure [19]. Of interest, the albumin gradient and NT-proBNP are not mutually exclusive, but rather they complement each other in that about two-thirds of false cardiac exudates with an albumin gradient less than 1.2 g/dl exhibit high levels of NT-proBNP and vice versa [21][22][23]24 & ]. In a composite of four studies from our center [21-23,24 & ], 82% of 60 misclassified cardiac effusions had pleural fluid NT-proBNP levels above 1500 pg/ml, the most widely accepted discriminatory threshold value.…”