NT‐brain natriuretic peptide levels in pleural fluid distinguish between pleural transudates and exudates

Abstract

Background: Pleural effusion is not pathognomic and distinguishing between transudates and exudates often presents a diagnostic dilemma. The purpose of our study was to examine whether the inclusion of pleural fluid brain natriuretic peptide (BNP) measurement into the analysis improves the diagnostic accuracy of pleural effusion. Methods: The pleural effusion of 14 patients with CHF (group A) and 14 subjects with different pleural pathology (group B) were analyzed. Samples of pleural fluid and serum were obtained from all patients on admission and biochemical analysis, bacterial and fungal culture, acid-fast bacilli smear and culture and cytology were performed on the pleural fluid. In vitro quantitative determination of N-terminal pro-Brain natriuretic peptide (NTproBNP) in serum and pleural fluid were performed by electrochemiluminescence immunoassay proBNP method on an Elecsys 2010 (Roche) analyzer. Results: The median NT-proBNP levels in groups A and B were 6295 pg/ml and 276 pg/ml, respectively: ( P=0.0001). There was no overlap between the two groups. While the Light's criteria had a sensitivity of 93% and specificity of 43% for transudates, the pleural fluid NT-proBNP level accurately differentiated between the two groups. Conclusions: The pleural NT-proBNP levels were elevated in all patients who had transudate. Therefore if the NT-proBNP levels of pleural effusion are within the normal range, transudate resulting from congestive heart failure can be ruled out. Our results suggest that the inclusion of pleural fluid NT-proBNP measurement in the routine diagnostic panel would enhance discrimination among the different causes of pleural effusions.

Comparison of Pleural Fluid N-Terminal Pro-Brain Natriuretic Peptide and Brain Natriuretic-32 Peptide Levels.

“…4,7,10 Kolditz et al 4 demonstrated elevated levels of NT-proBNP in both serum and pleural fl uid of individuals with pleural effusions arising from cardiac disease and also described a high diagnostic accuracy of pleural fl uid NT-proBNP with an AUC of 0.98 (95% CI, 0.96-1.00). Additional investigations have confi rmed the accuracy of NT-proBNP in identifying CHF-related pleural effusions, with Han et al 11 reporting an AUC of 0.996 (95% CI, 0.990-1.003).…”

Pleural Fluid Amino-Terminal Brain Natriuretic Peptide in Patients With Pleural Effusions

“…Tomcsányi et al 15 showed that the criteria of Light et al 1 had a sensitivity of 93% and specificity of 43% for transudates. However, the pleural fluid NT-proBNP accurately differentiated between the 2 groups.…”

“…Our results were in accordance with the recent studies that explored the diagnostic value of BNP and NT-proBNP in the etiology of pleural effusions. 2,[15][16][17][18][19][20] Han et al 2 measured pleural fluid and serum NT-proBNP levels in a consecutive series of 98 patients with heart failure and in 142 patients with other causes, and found that pleural fluid NT-proBNP levels among the heart-failure patients were significantly higher than others. Similarly, Porcel et al 18 retrospectively examined 117 patients with pleural effusion and found that the pleural fluid levels of NTproBNP were significantly higher in patients with cardiac transudates than in patients with effusion of other causes.…”

NT-proBNP AT DIAGNOSIS OF PLEURAL EFFUSIONS DUE TO HEART

“…Plevral efüzyonun nedenini belirlemek amacıyla plevral sıvı NT-proBNP ile yapılmış çalışmaların ayrıntı-lı sonuçları Tablo 1'de verilmiştir (26)(27)(28)(29)(30)(31)(32)(33)(34)(35). Bu tabloda Kolditz ve ark.…”