Pleural Fluid Amino-Terminal Brain Natriuretic Peptide in Patients With Pleural Effusions

Abstract

BACKGROUND: Definite diagnosis of transudative or exudative pleural fluids often presents a diagnostic dilemma. The aim of this study was to evaluate whether amino-terminal brain natriuretic peptide (NT-proBNP) levels in pleural fluid has a diagnostic value for discriminating heart-failurerelated pleural effusions from non-heart-failure effusions. METHODS: Sixty-six subjects (40 male, mean age 61 ؎ 18 y) with pleural effusions were included. Samples of pleural fluid and serum were obtained simultaneously from each subject. Biochemical analysis, bacterial and fungal culture, acid-fast bacilli smear and culture, and cytology were performed on the pleural fluid. RESULTS: Subjects with heart-failure-related pleural effusion had significantly higher pleural NT-proBNP levels than other subjects (P < .001). Pleural and serum NT-proBNP measures were closely correlated (r ‫؍‬ 0.90, P < .001). An NT-proBNP cutoff value of > 2,300 pg/mL in pleural fluid had a sensitivity of 70.8%, a specificity of 97.6%, and positive and negative predictive values of 94.4% and 85.4%, respectively, for discriminating transudates caused by heart failure from exudates. Eight heart-failure subjects were misclassified as exudates by Light's criteria, 5 of whom received diuretics before thoracentesis. All misclassified subjects had pleural NT-proBNP levels higher than 1,165 pg/mL, which predicted heart-failure-associated transudates with 95.8% sensitivity and 85.7% specificity. CONCLUSIONS: Pleural fluid NT-proBNP measurement in the routine diagnostic panel may be useful in differentiation of heart-failure-related pleural effusions and exudative pleural fluids with reasonable accuracy, especially in heart-failure patients treated with diuretics.

Cautious Application of Pleural N-Terminal Pro-B-Type Natriuretic Peptide in Diagnosis of Congestive Heart Failure Pleural Effusions among Critically Ill Patients

“…One limitation of the present study needs to be addressed. The kit for assaying NT-proBNP in this study differs from the commonly used electrochemiluminescence immunoassay for NT-proBNP offered by Roche Diagnostics; however, the diagnostic cutoff of NT-proBNP we established is well within the range reported in other studies using the Roche assay [5] , [10] , [12] , [14] , [16] , [17] .…”

Diagnostic Accuracy of Natriuretic Peptides for Heart Failure in Patients with Pleural Effusion: A Systematic Review and Updated Meta-Analysis

“…In total, 14 studies involving 599 patients with HF and 1055 patients without HF were included in the present work [ 25 – 38 ]. A flow chart depicting the study selection process is shown in Fig 1 .…”

“…The sample size of these 14 studies ranged from 28 to 398. Half of the studies were prospective [ 25 , 27 , 32 , 34 – 36 , 38 ], five were retrospective [ 26 , 28 – 31 ], and the remaining two did not report their design characteristics [ 33 , 37 ]. The control groups generally comprised patients with malignancy, tuberculosis, parapneumonic effusion, pulmonary embolism, hepatic hydrothorax, postcardiac injury syndrome, collagen disease, and other conditions.…”

“…One study [ 37 ] was labeled “unknown” because the author did not report the method of patient recruitment. The index test domain of nine studies was labeled “high” because, although the sample sizes were small, the threshold was not prespecified [ 25 , 29 , 31 , 33 , 35 – 38 ]. This domain in one study was labeled “unknown” because the author did not report whether the index test results were interpreted without knowledge of the reference standard results [ 32 , 34 ].…”

Issues of differential diagnosis of pleural effusions

“…Мозговой натрийуретический пептид -нейрогормон, высвобождаемый кардиомиоцитами желудочков в ответ на повышение давления или объема. Позволяет диагностировать плевральные выпоты сердечного генеза с чувствительностью и специфичностью 94%, позволяет выявлять 80% транссудатов, пропущенных по критериям Лайта [34,36]. В связи с высоким уровнем корреляции его содержания в плазме крови и в выпоте, нет необходимости исследовать уровень мозгового натрийуретического пептида в плевральной жидкости при его повышенном уровне в крови [35].…”