Diagnostic Value of N-Terminal Pro-Brain Natriuretic Peptide in Pleural Effusions of Cardiac Origin

Valdés, Luis; San José, Esther; Pose, Antonio; González-Barcala, Francisco J.; Álvarez-Dobaño, José M.; Ferreiro, Lucía; Anchorena, Christian; Pereyra, Marco F.; González-Juanatey, José R.; Sahn, Steven A.

doi:10.1016/S1579-2129(11)70060-X

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Abstract

Introduction

The diagnosis of cardiogenic pleural effusion (PE) is often difficult to make. The objective of our study was to evaluate the diagnostic usefulness of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in PE patients with heart failure, in pleural fluid (PF) and serum (S), and to compare the cholesterol in pleural fluid (CHOL PF) and in serum (CHOL S) with the Light criteria.

Patients and methods

All the biomarkers were evaluated in 398 PF (26.9% transudates). The area under the curve (AUC) quantified the overall diagnostic precision. The diagnostic precision of the different parameters was also assessed using the ROC curves.

Results

The AUC of the ROC for pleural fluid NT-proBNP was 0.894, with no significant differences with CHOL PF (0.914) or with the Light criteria (0.896). The sensitivity, specificity, the positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 85.1% (94.1% for CHOL PF), 79.9% (90.2% for the Light criteria), 4.24 (7.27 for the Light criteria) and 0.19 (0.07 for CHOL PF), respectively. The combination of NT-proBNP in PF ≥ 276 pg/ml and CHOL PF ≤ 57 mg/dL managed to classify the highest number of PE correctly (sensitivity 97.8%, specificity 85.4%).

Conclusions

The diagnostic yield of NT-proBNP in cardiogenic PE is not superior to the CHOL PF or the Light criteria, although it could be diagnostic in transudates of another origin.

Keywords:

Diagnosis

Heart failure

NT-pro-BNP

Pleural effusion

Resumen

Introducción

El diagnóstico del derrame pleural (DP) cardiogénico plantea dificultades con frecuencia. El objetivo de nuestro estudio fue evaluar la utilidad diagnóstica en el DP en pacientes con insuficiencia cardíaca, de los niveles del fragmento N terminal del pro-péptido natriurético cerebral (NT-proBNP), tanto en líquido pleural (LP) como en sangre (S), y compararlo con los criterios de Light, el colesterol en líquido pleural (COL LP) y en suero (COL S).

Pacientes y método

Todos los biomarcadores fueron evaluados en 398 DP (26,9% trasudados). El área bajo la curva (ABC) cuantificó la precisión diagnóstica global; y mediante curvas ROC se evaluó la precisión diagnóstica de los diversos parámetros.

Resultados

El ABC ROC para el NT-proBNP pleural fue 0,894, sin diferencias significativas con el COL LP (0,914) ni con los criterios de Light (0,896). La sensibilidad, especificidad, razón de probabilidad positiva (RPP) y razón de probabilidad negativa (RPN) fueron 85,1% (94,1% para COL LP), 79,9% (90,2% para los criterios de Light), 4,24 (7,27 para los criterios de Light) y 0,19 (0,07 para COL LP), respectivamente. La combinación del NT-proBNP en LP ≥ 276 pg/ml y COL LP ≤ 57 mg/dL consiguieron clasificar el mayor número de DP correctamente (sensibilidad 97,8%, especificidad 85,4%).

Conclusiones

El rendimiento diagnóstico del NT-proBNP en DP cardiogénicos no es superior al COL LP ni a los criterios de Light, aunque pudiera ser diagnóstico en trasudados de otro origen.

Palabras clave:

Diagnóstico

Insuficiencia cardíaca

NT-pro-BNP

Derrame pleural

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