title: Differentiation of Cardiac from Noncardiac Pleural Effusions in Cats using Second-Generation Quantitative and Point-of-Care NT-proBNP Measurements.
abstract: BACKGROUND
  Pleural effusion is a common cause of dyspnea in cats. N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurement, using a first-generation quantitative ELISA, in plasma and pleural fluid differentiates cardiac from noncardiac causes of pleural effusion.
  
  
  OBJECTIVE
  To determine whether NT-proBNP measurements using second-generation quantitative ELISA and point-of-care (POC) tests in plasma and pleural fluid distinguish cardiac from noncardiac pleural effusions and how results compare to the first-generation ELISA.
  
  
  METHODS
  Thirty-eight cats (US cohort) and 40 cats (UK cohort) presenting with cardiogenic or noncardiogenic pleural effusion.
  
  
  METHODS
  Prospective cohort study. Twenty-one and 17 cats in the US cohort, and 22 and 18 cats in the UK cohort were classified as having cardiac or noncardiac pleural effusion, respectively. NT-proBNP concentrations in paired plasma and pleural fluid samples were measured using second-generation ELISA and POC assays.
  
  
  RESULTS
  The second-generation ELISA differentiated cardiac from noncardiac pleural effusion with good diagnostic accuracy (plasma: sensitivity, 95.2%, specificity, 82.4%; pleural fluid: sensitivity, 100%, specificity, 76.5%). NT-proBNP concentrations were greater in pleural fluid (719 pmol/L (134-1500)) than plasma (678 pmol/L (61-1500), P = 0.003), resulting in different cut-off values depending on the sample type. The POC test had good sensitivity (95.2%) and specificity (87.5%) when using plasma samples. In pleural fluid samples, the POC test had good sensitivity (100%) but low specificity (64.7%). Diagnostic accuracy was similar between first- and second-generation ELISA assays.
  
  
  CONCLUSIONS
  Measurement of NT-proBNP using a quantitative ELISA in plasma and pleural fluid or POC test in plasma, but not pleural fluid, distinguishes cardiac from noncardiac causes of pleural effusion in cats.
authors.affiliation: Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Hezzell
authors.affiliation: Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA.
authors.forename: J E
authors.initials: JE
authors.lastname: Rush
authors.affiliation: Department of Clinical Sciences and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK.
authors.forename: K
authors.initials: K
authors.lastname: Humm
authors.affiliation: Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA.
authors.forename: E A
authors.initials: EA
authors.lastname: Rozanski
authors.affiliation: Department of Clinical Sciences and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK.
authors.forename: J
authors.initials: J
authors.lastname: Sargent
authors.affiliation: Department of Clinical Sciences and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK.
authors.forename: D J
authors.initials: DJ
authors.lastname: Connolly
authors.affiliation: Department of Clinical Sciences and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK.
authors.forename: A
authors.initials: A
authors.lastname: Boswood
authors.affiliation: Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: M A
authors.initials: MA
authors.lastname: Oyama
mesh_terms: D000818:Animals; D001826:Body Fluids / Q000737:chemistry; D002371:Cat Diseases / Q000175:diagnosis*; D002415:Cats; D015331:Cohort Studies; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods / Q000662:veterinary; D005122:Exudates and Transudates / Q000737:chemistry; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000175:diagnosis / Q000662:veterinary*; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000737:chemistry / Q000378:metabolism*; D010446:Peptide Fragments / Q000737:chemistry / Q000378:metabolism*; D010996:Pleural Effusion / Q000175:diagnosis / Q000209:etiology / Q000662:veterinary*; D019095:Point-of-Care Systems; D012680:Sensitivity and Specificity
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Biomarker; Blood testing; Cardiomyopathy; Dyspnea; Natriuretic peptide
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