title: Diagnostic Accuracy of Natriuretic Peptides for Heart Failure in Patients with Pleural Effusion: A Systematic Review and Updated Meta-Analysis.
abstract: BACKGROUND
  Previous studies have reported that natriuretic peptides in the blood and pleural fluid (PF) are effective diagnostic markers for heart failure (HF). These natriuretic peptides include N-terminal pro-brain natriuretic peptide (NT-proBNP), brain natriuretic peptide (BNP), and midregion pro-atrial natriuretic peptide (MR-proANP). This systematic review and meta-analysis evaluates the diagnostic accuracy of blood and PF natriuretic peptides for HF in patients with pleural effusion.
  
  
  METHODS
  PubMed and EMBASE databases were searched to identify articles published in English that investigated the diagnostic accuracy of BNP, NT-proBNP, and MR-proANP for HF. The last search was performed on 9 October 2014. The quality of the eligible studies was assessed using the revised Quality Assessment of Diagnostic Accuracy Studies tool. The diagnostic performance characteristics (sensitivity, specificity, and other measures of accuracy) were pooled and examined using a bivariate model.
  
  
  RESULTS
  In total, 14 studies were included in the meta-analysis, including 12 studies reporting the diagnostic accuracy of PF NT-proBNP and 4 studies evaluating blood NT-proBNP. The summary estimates of PF NT-proBNP for HF had a diagnostic sensitivity of 0.94 (95% confidence interval [CI]: 0.90-0.96), specificity of 0.91 (95% CI: 0.86-0.95), positive likelihood ratio of 10.9 (95% CI: 6.4-18.6), negative likelihood ratio of 0.07 (95% CI: 0.04-0.12), and diagnostic odds ratio of 157 (95% CI: 57-430). The overall sensitivity of blood NT-proBNP for diagnosis of HF was 0.92 (95% CI: 0.86-0.95), with a specificity of 0.88 (95% CI: 0.77-0.94), positive likelihood ratio of 7.8 (95% CI: 3.7-16.3), negative likelihood ratio of 0.10 (95% CI: 0.06-0.16), and diagnostic odds ratio of 81 (95% CI: 27-241). The diagnostic accuracy of PF MR-proANP and blood and PF BNP was not analyzed due to the small number of related studies.
  
  
  CONCLUSIONS
  BNP, NT-proBNP, and MR-proANP, either in blood or PF, are effective tools for diagnosis of HF. Additional studies are needed to rigorously evaluate the diagnostic accuracy of PF and blood MR-proANP and BNP for the diagnosis of HF.
authors.affiliation: Department of Laboratory Medicine, Wuxi Second People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China; Department of Laboratory Medicine, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu, China.
authors.forename: Zhi-Jun
authors.initials: ZJ
authors.lastname: Han
authors.affiliation: Department of Laboratory Medicine, Wuxi Second People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China.
authors.forename: Xiao-Dan
authors.initials: XD
authors.lastname: Wu
authors.affiliation: Department of Laboratory Medicine, Wuxi Second People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China.
authors.forename: Juan-Juan
authors.initials: JJ
authors.lastname: Cheng
authors.affiliation: Department of Cardiology, Wuxi Second People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China.
authors.forename: Shi-Di
authors.initials: SD
authors.lastname: Zhao
authors.affiliation: Department of Laboratory Medicine, Wuxi Second People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China.
authors.forename: Ming-Zhu
authors.initials: MZ
authors.lastname: Gao
authors.affiliation: Department of Laboratory Medicine, Wuxi Second People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China.
authors.forename: Hong-Yu
authors.initials: HY
authors.lastname: Huang
authors.affiliation: Department of Laboratory Medicine, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Gu
authors.affiliation: Department of Laboratory Medicine, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Ma
authors.affiliation: Emergency Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Gerontology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Jun-Hong
authors.initials: JH
authors.lastname: Wang
authors.affiliation: Department of Cardiology, Wuxi Second People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China.
authors.forename: Cheng-Jian
authors.initials: CJ
authors.lastname: Yang
authors.affiliation: Department of Laboratory Medicine, Wuxi Second People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China.
authors.forename: Zi-He
authors.initials: ZH
authors.lastname: Yan
mesh_terms: D009320:Atrial Natriuretic Factor / Q000032:analysis / Q000097:blood; D015415:Biomarkers / Q000032:analysis / Q000097:blood*; D005122:Exudates and Transudates / Q000737:chemistry*; D006333:Heart Failure / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000032:analysis / Q000097:blood; D045265:Natriuretic Peptides / Q000032:analysis / Q000097:blood*; D010446:Peptide Fragments / Q000032:analysis / Q000097:blood; D010996:Pleural Effusion / Q000097:blood* / Q000150:complications / Q000378:metabolism; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D045265:Natriuretic Peptides; D010446:Peptide Fragments; C552580:midregional pro-atrial natriuretic peptide, human; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor