title: Comparison of pleural N-terminal pro-B-type natriuretic peptide, midregion pro-atrial natriuretic peptide and mid-region pro-adrenomedullin for the diagnosis of pleural effusions associated with cardiac failure.
abstract: OBJECTIVE
  The purpose of this study was to compare the diagnostic utility of pleural fluid N-terminal pro-B-type natriuretic peptide (NT-proBNP), midregion pro-atrial natriuretic peptide (MR-proANP) and midregion pro-adrenomedullin (MR-proADM) for discriminating heart failure (HF)-associated effusions.
  
  
  METHODS
  NT-proBNP, MR-proANP and MR-proADM were measured by commercially available methodologies in the pleural fluid of a retrospective cohort of 185 consecutive patients with pleural effusions, of whom 95 had acute decompensated HF. Receiver-operating characteristic and area under the curve (AUC) analyses allowed comparisons of the discriminative properties of these biomarkers to be made at their optimal cut-off points.
  
  
  RESULTS
  The diagnostic accuracy of NT-proBNP and MR-proANP for HF as quantified by the AUC was 0.935 and 0.918, respectively, whereas MR-proADM was of limited value (AUC = 0.62). A pleural fluid MR-proANP >260 pmol/L or NT-proBNP >1700 pg/mL argues for HF (likelihood ratio (LR) positive >5), while levels below these cut-off values significantly decrease the probability of having the disease (respective LR negative 0.19 and 0.10). The optimal cut-off points for natriuretic peptides were influenced by age, renal function and body mass index. Finally, both NT-proBNP and the albumin gradient correctly identified more than 80% of those cardiac effusions misclassified as exudates by standard criteria.
  
  
  CONCLUSIONS
  MR-proANP is as valuable a diagnostic tool as NT-proBNP for diagnosing or excluding HF as the cause of pleural effusion.
authors.affiliation: Pleural Diseases Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, Biomedical Research Institute of Lleida, Lleida, Spain. jporcelp@yahoo.es
authors.forename: José M
authors.initials: JM
authors.lastname: Porcel
authors.forename: Silvia
authors.initials: S
authors.lastname: Bielsa
authors.forename: José L
authors.initials: JL
authors.lastname: Morales-Rull
authors.forename: Carme
authors.initials: C
authors.lastname: Civit
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Cao
authors.forename: Richard W
authors.initials: RW
authors.lastname: Light
authors.forename: Aureli
authors.initials: A
authors.lastname: Esquerda
mesh_terms: D053607:Adrenomedullin / Q000032:analysis*; D000368:Aged; D000369:Aged, 80 and over; D009320:Atrial Natriuretic Factor / Q000032:analysis*; D015415:Biomarkers / Q000032:analysis; D003937:Diagnosis, Differential; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications* / Q000378:metabolism; D006801:Humans; D007118:Immunoassay; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000032:analysis*; D010446:Peptide Fragments / Q000032:analysis*; D010996:Pleural Effusion / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D011498:Protein Precursors / Q000032:analysis*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D011498:Protein Precursors; C574167:mid-regional pro-adrenomedullin, human; C552580:midregional pro-atrial natriuretic peptide, human; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D053607:Adrenomedullin; D009320:Atrial Natriuretic Factor