title: The importance of pleural fluid and serum NT-proBNP levels in differentiating pleural effusion due to heart failure from other causes of effusion.
abstract: OBJECTIVE
  Pleural effusion due to congestive heart failure (CHF) typically are transudates. Light's criteria may be insufficient in determining if the pleural effusion is transudative or exudative in patients with CHF. The aim of our study was to assess the diagnostic performance of the amino-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) in pleural fluid and serum for the identification of pleural effusion owing to heart failure.
  
  
  METHODS
  The study prospectively evaluated NT-proBNP in serum and pleural fluid from patients with effusion owing to heart failure (n=51) and other causes (n=64). Measurements were made of levels of NT-proBNP by an electrochemiluminiscence immunoassay. The discriminative properties of NT-proBNP levels in identifying pleural effusion due to heart failure were determined by receiver operating characteristic curve (ROC) analysis and compared to the diagnostic value of finding a transudate by Light's criteria and serum-pleural fluid albumin gradients.
  
  
  RESULTS
  Serum and pleural fluid NT-proBNP levels were significantly elevated in patients with pleural effusion owing to heart failure. The area under ROC for the diagnosis of pleural effusion from heart failure was similar for pleural fluid (0.973, 95% CI: 0.914-0.995) and serum (0.968, 95% CI: 0.890-0.989) NT-proBNP.
  
  
  CONCLUSIONS
  NT-proBNP levels in either pleural fluid or serum have high diagnostic values and they are easily useable parameters in the diagnosis of heart failure-related pleural effusion.
authors.affiliation: Department of Chest Diseases, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey. drekremcs@yahoo.com
authors.forename: Ekrem Cengiz
authors.initials: EC
authors.lastname: Seyhan
authors.forename: Sedat
authors.initials: S
authors.lastname: Altin
authors.forename: Erdogan
authors.initials: E
authors.lastname: Cetinkaya
authors.forename: Sinem
authors.initials: S
authors.lastname: Sokucu
authors.forename: Mehmet Zeki
authors.initials: MZ
authors.lastname: Gunluoglu
authors.forename: Adalet
authors.initials: A
authors.lastname: Demir
authors.forename: Pelin
authors.initials: P
authors.lastname: Korkmaz
authors.forename: Halim
authors.initials: H
authors.lastname: Issever
mesh_terms: D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D035422:Pleural Cavity / Q000378:metabolism*; D010996:Pleural Effusion / Q000175:diagnosis* / Q000209:etiology* / Q000378:metabolism; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain