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

Archivos de Bronconeumología

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Vol. 47. Issue 5.

Pages 246-251 (January 2011)

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Pages 246-251 (January 2011)

Original Article

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

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

Valor diagnóstico de los niveles del N-terminal pro-péptido natriurético cerebral en los derrames pleurales de origen cardiaco

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Luis Valdésa,

Corresponding author

luis.valdes.cuadrado@sergas.es

Corresponding author.

, Esther San Joséb, Antonio Posec, Francisco J. González-Barcalaa, José M. Álvarez-Dobañoa, Lucía Ferreiroa, Christian Anchorenaa, Marco F. Pereyraa, José R. González-Juanateyd, Steven A. Sahne

a Servicio de Neumología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain

b Servicio de Análisis Clínicos, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain

c Servicio de Medicina Interna, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain

d Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain

e Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina, USA

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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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References

[1.]

G.T. Kinasewitz, K.R. Jones.

Effusions from cardiac diseases.

Textbook of pleural diseases, 2nd ed, pp. 315-321

[2.]

A. Eid, J.I. Keddissi, M. Samaha, M.M. Tawk, K. Kimmell, G.T. Kinasewitz.

Exudative effusions in congestive heart failure.

Chest, 122 (2002), pp. 1518-1523

Medline

[3.]

P.G. Steg, L. Joubin, J. McCord, W.T. Abraham, J.E. Hollander, T. Omland, et al.

B-type natriuretic peptide and echocardiographic determination of ejection fraction in the diagnosis of congestive heart failure in patients with acute dyspnea.

Chest, 128 (2005), pp. 21-29

http://dx.doi.org/10.1378/chest.128.1.21 | Medline

[4.]

R.W. Light.

Clinical practice. Pleural effusion.

N Engl J Med, 346 (2002), pp. 1971-1977

http://dx.doi.org/10.1056/NEJMcp010731 | Medline

[5.]

L. Valdés, A. Pose, J. Suárez, J.R. Gonzalez-Juanatey, A. Sarandeses, E. San José, et al.

Cholesterol: a useful parameter for distinguishing between pleural exudates and transudates.

Chest, 99 (1991), pp. 1097-1102

Medline

[6.]

I. Gotsman, Z. Fridlender, A. Meirowitz, D. Dratva, M. Muszkat.

The evaluation of pleural effusions in patients with heart failure.

Am J Med, 111 (2001), pp. 375-378

Medline

[7.]

J.E. Heffner, S.A. Sahn, L.K. Brown.

Multilevel likelihood ratios for identifying exudative pleural effusions.

Chest, 121 (2002), pp. 1916-1920

Medline

[8.]

S. Romero-Candeira, C. Fernández, C. Martín, J. Sánchez-Paya, L. Hernández.

Influence of diuretics on the concentration of proteins and other components of pleural transudates in patients with heart failure.

Am J Med, 110 (2001), pp. 681-686

Medline

[9.]

S.C. Chakko, S.H. Caldwell, P.P. Sforza.

Treatment of congestive heart failure Its effect on pleural fluid chemistry.

Chest, 95 (1989), pp. 798-802

Medline

[10.]

L.J. Burgess, F.J. Maritz, J.J. Taljaard.

Comparative analysis of the biochemical parameters used to distinguish between pleural transudates and exudates.

Chest, 107 (1995), pp. 1604-1609

Medline

[11.]

J.M. Porcel, M. Vives, G. Cao, A. Esquerda, M. Rubio, C. Rivas.

Measurement of pro-brain natriuretic peptide in pleural fluid for the diagnosis of pleural effusions due to heart failure.

Am J Med, 116 (2004), pp. 417-420

http://dx.doi.org/10.1016/j.amjmed.2003.11.008 | Medline

[12.]

J. Tomcsanyi, E. Nagy, M. Somloi, J. Moldvay, A. Bezzegh.

NT-brain natriuretic peptide levels in pleural fluid distinguish between pleural transudates and exudates.

Eur J Heart Fail, 6 (2004), pp. 753-756

http://dx.doi.org/10.1016/j.ejheart.2003.11.017 | Medline

[13.]

A. Gegenhuber, T. Mueller, B. Dieplinger, K. Lenz, W. Poelz, M. Haltmayers.

Plasma B-type natriuretic peptide in patients with pleural effusions.

Chest, 128 (2005), pp. 1003-1009

http://dx.doi.org/10.1378/chest.128.2.1003 | Medline

[14.]

M. Kolditz, M. Halank, C.S. Schiemanck, A. Schmeisser, G. Höffken.

High diagnostic accuracy of NT-proBNP for cardiac origin of pleural effusions.

Eur Respir J, 28 (2006), pp. 144-150

http://dx.doi.org/10.1183/09031936.06.00113205 | Medline

[15.]

J.M. Porcel, J. Chorda, G. Cao, A. Esquerda, A. Ruiz-González, M. Vives.

Comparing serum and pleural fluid pro-brain natriuretic peptide (NT-proBNP) levels with pleural-to-serum albumin gradient for the identification of cardiac effusions misclassified by Light's criteria.

Respirology, 12 (2007), pp. 654-659

http://dx.doi.org/10.1111/j.1440-1843.2007.01109.x | Medline

[16.]

H. Liao, M.J. Na, O. Dikensoy, K.B. Lane, B. Randal, R.W. Light.

Diagnostic value of pleural fluid N-terminal pro-brain natriuretic peptide levels in patients with cardiovascular diseases.

Respirology, 13 (2008), pp. 53-57

http://dx.doi.org/10.1111/j.1440-1843.2007.01191.x | Medline

[17.]

C.H. Han, J.E. Choi, J.H. Chung.

Clinical utility of pleural fluid NT-pro brain natriuretic peptide (NT-proBNP) in patients with pleural effusions.

Inter Med, 47 (2008), pp. 1669-1674

[18.]

J.M. Porcel, M. Martínez-Alonso, G. Cao, S. Bielsa, A. Sopena, A. Esquerda.

Biomarkers of heart failure in pleural fluid.

Chest, 136 (2009), pp. 671-677

http://dx.doi.org/10.1378/chest.09-0270 | Medline

[19.]

A.S. Maisel, P. Krishnaswamy, R.M. Nowak, J. McCord, J.E. Hollander, P. Duc, et al.

Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure.

N Engl J Med, 347 (2002), pp. 161-167

http://dx.doi.org/10.1056/NEJMoa020233 | Medline

[20.]

S.A. Sahn, J.E. Heffner.

Pleural fluid analysis.

Textbook of pleural diseases, 2nd ed, pp. 209-226

[21.]

M.H. Zweig, G. Campbell.

Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine.

Clinical Chemistry, 39 (1993), pp. 561-577

Medline

[22.]

S. Romero-Candeira, L. Hernández, S. Romero-Brufao, D. Orts, C. Fernández, C. Martín.

Is it meaningful to use biochemical parameters to discriminate between transudative and exudative pleural effusions?.

Chest, 122 (2002), pp. 1524-1529

Medline

[23]

M. Radvan, P. Svoboda, J. Radvanová, J. Stumar, P. Scheer.

Brain natriuretic peptide in decompensation of liver cirrhosis in non-cardiac patients.

Hepatogastroenterology, 56 (2009), pp. 181-185

Medline

[24]

J. Pimenta, C. Paulo, A. Gomes, S. Silva, P. Rocha-Gonçalves, P. Bettencourt.

B-type natriuretic peptide is related to cardiac function and prognosis in hospitalized patients with decompensated cirrhosis.

Liver Int, 30 (2010), pp. 1059-1066

http://dx.doi.org/10.1111/j.1478-3231.2010.02266.x | Medline

[25]

L.C. Costello-Boerrigter, G. Boerrigter, M.M. Rendfield, R.J. Rodeheffer, L.H. Urban, D.W. Mahoney, et al.

Amino-terminal pro-B-type natriuretic peptide and b-type natriuretic peptide in the general community.

J Am Coll Cardiol, 47 (2006), pp. 345-353

http://dx.doi.org/10.1016/j.jacc.2005.09.025 | Medline

[26]

J. Ordonez-Llanos, P.O. Collinson, R.H. Christenson.

Amino-terminal pro-B-type natriuretic peptide: analytic considerations.

Am J Cardiol, 101 (2008), pp. 9A-15A

[27]

W.H. Tang, G.S. Francis, D.A. Morrow, L.K. Newby, C.P. Cannon, R.L. Jesse, et al.

National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: clinical utilization of cardiac biomarker testing in heart failure.

Clin Biochem, 41 (2008), pp. 210-221

http://dx.doi.org/10.1016/j.clinbiochem.2007.07.002 | Medline

[28]

J. Ybarra, F. Planas, F. Navarro-López, S. Pujadas, J. Pujadas, J. Jurado, et al.

Association between sleep-disordered breathing, amino terminal pro-brain natriuretic peptide (NT-proBNP) levels and insulin resistance in morbidly obese young women.

Eur J Intern Med, 20 (2009), pp. 174-181

http://dx.doi.org/10.1016/j.ejim.2008.01.019 | Medline

[29]

V. Villena, A. López Encuentra, J. Echave-Sustaeta, C. Álvarez Martínez, P. Martín Escribano.

Estudio prospective de 1.000 pacientes consecutivos con derrame pleura. Etiología del derrame y características de los pacientes.

Arch Bronconeumol, 38 (2002), pp. 21-26

Medline

[30]

N. Johnston, T. Jernberg, B. Lindahl, J. Lindback, M. Stridsberg, A. Larsson, et al.

Biochemical indicators of cardiac and renal function in a healthy elderly population.

Clin Biochem, 37 (2004), pp. 210-216

http://dx.doi.org/10.1016/j.clinbiochem.2003.11.002 | Medline

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