title: Serum B-type natriuretic peptide in the initial workup of patients with new onset ascites: a diagnostic accuracy study.
abstract: Heart failure (HF) is, after cirrhosis, the second-most common cause of ascites. Serum B-type natriuretic peptide (BNP) plays an important role in the diagnosis of HF. Therefore, we hypothesized that BNP would be useful in the differential diagnosis of ascites. Consecutive patients with new onset ascites were prospectively enrolled in this cross-sectional study. All patients had measurements of serum-ascites albumin gradient (SAAG), total protein concentration in ascitic fluid, serum, and ascites BNP. We enrolled 218 consecutive patients with ascites resulting from HF (n = 44), cirrhosis (n = 162), peritoneal disease (n = 10), and constrictive pericarditis (n = 2). Compared to SAAG and/or total protein concentration in ascites, the test that best discriminated HF-related ascites from other causes of ascites was serum BNP. A cutoff of >364 pg/mL (sensitivity 98%, specificity 99%, and diagnostic accuracy 99%) had the highest positive likelihood ratio (168.1); that is, it was the best to rule in HF-related ascites. Conversely, a cutoff ≤ 182 pg/mL had the lowest negative likelihood ratio (0.0) and was the best to rule out HF-related ascites. These findings were confirmed in a 60-patient validation cohort.
  
  
  CONCLUSIONS
  Serum BNP is more accurate than ascites analyses in the diagnosis of HF-related ascites. The workup of patients with new onset ascites could be streamlined by obtaining serum BNP as an initial test and could forego the need for diagnostic paracentesis, particularly in cases where the cause of ascites is uncertain and/or could be the result of HF.
authors.affiliation: Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
authors.forename: Alberto Q
authors.initials: AQ
authors.lastname: Farias
authors.forename: Odilson M
authors.initials: OM
authors.lastname: Silvestre
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Garcia-Tsao
authors.forename: Luis F B
authors.initials: LF
authors.lastname: da Costa Seguro
authors.forename: Daniel F
authors.initials: DF
authors.lastname: de Campos Mazo
authors.forename: Fernando
authors.initials: F
authors.lastname: Bacal
authors.forename: José L
authors.initials: JL
authors.lastname: Andrade
authors.forename: Luciana L
authors.initials: LL
authors.lastname: Gonçalves
authors.forename: Célia
authors.initials: C
authors.lastname: Strunz
authors.forename: Danusa S
authors.initials: DS
authors.lastname: Ramos
authors.forename: Demerson
authors.initials: D
authors.lastname: Polli
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pugliese
authors.forename: Ana C T
authors.initials: AC
authors.lastname: Rodrigues
authors.forename: Meive S
authors.initials: MS
authors.lastname: Furtado
authors.forename: Flair J
authors.initials: FJ
authors.lastname: Carrilho
authors.forename: Luiz A C
authors.initials: LA
authors.lastname: D'Albuquerque
mesh_terms: D000328:Adult; D000368:Aged; D001201:Ascites / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000378:metabolism; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010532:Peritoneal Diseases / Q000150:complications / Q000175:diagnosis / Q000378:metabolism; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D020097:Natriuretic Peptide, Brain