title: Diagnostic value of N-terminal pro-brain natriuretic peptide in pleural effusions of cardiac origin.
abstract: BACKGROUND
  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 blood (B), and to compare the cholesterol in pleural fluid (CHOL PF) and in serum (CHOL S) with the Light criteria.
  
  
  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 probability ratio (PPR) and negative probability ratio (NPR) 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 PE correctly (sensitivity 97.8%, specificity 85.4%).
  
  
  CONCLUSIONS
  The diagnostic yield of NT-proBNP in cardiogenic PE is not superior to the CHOL LP or the Light criteria, although it could be diagnostic in transudates of another origin.
authors.affiliation: Servicio de Neumología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, España. luis.valdes.cuadrado@sergas.es
authors.forename: Luis
authors.initials: L
authors.lastname: Valdés
authors.forename: Esther San
authors.initials: ES
authors.lastname: José
authors.forename: Antonio
authors.initials: A
authors.lastname: Pose
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: González-Barcala
authors.forename: José M
authors.initials: JM
authors.lastname: Alvarez-Dobaño
authors.forename: Lucía
authors.initials: L
authors.lastname: Ferreiro
authors.forename: Christian
authors.initials: C
authors.lastname: Anchorena
authors.forename: Marco F
authors.initials: MF
authors.lastname: Pereyra
authors.forename: José R
authors.initials: JR
authors.lastname: González-Juanatey
authors.forename: Steven A
authors.initials: SA
authors.lastname: Sahn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D045604:Extracellular Fluid / Q000737:chemistry; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000032:analysis* / Q000097:blood; D010446:Peptide Fragments / Q000032:analysis* / Q000097:blood; D010996:Pleural Effusion / Q000097:blood / Q000175:diagnosis* / Q000209:etiology*; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain