The importance of pleural fluid and serum NT-proBNP levels in differentiating pleural effusion due to heart failure from other causes of effusion.
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.
Seyhan
Ekrem Cengiz
EC
Department of Chest Diseases, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey. drekremcs@yahoo.com
Altin
Sedat
S
Cetinkaya
Erdogan
E
Sokucu
Sinem
S
Gunluoglu
Mehmet Zeki
MZ
Demir
Adalet
A
Korkmaz
Pelin
P
Issever
Halim
H
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
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain