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Published online before print February 15, 2006
Eur Respir J 2006, doi:10.1183/09031936.06.00113205
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ORIGINAL ARTICLE

High diagnostic accuracy of NT-proBNP for cardiac origin of pleural effusions

M. Kolditz 1*, M. Halank 1, S. Schiemanck 1, A. Schmeisser 2, G. Höffken 1

1 Dept of Pulmonology, Medical Clinic I, University Hospital Carl Gustav Carus, Dresden, Germany
2 Dept of Cardiology, Medical Clinic II, University of Technology Dresden, Germany

* To whom correspondence should be addressed. E-mail: martin.kolditz{at}uniklinikum-dresden.de.


  Abstract

A prospective study was performed to evaluate the diagnostic accuracy of NT-proBNP measured simultaneously in serum and pleural fluid to identify pleural effusions due to heart failure.

Pleural fluid and serum samples from all patients presenting for thoracentesis between April 2004 and May 2005 were simultaneously collected. The discriminative properties of NT-proBNP to identify pleural effusions due to heart failure were determined by ROC-curve analysis and compared to the diagnostic value of finding a transudate by Light's criteria.

93 patients were evaluated, 27% with cardiac effusion and 73% with exudative effusions of various causes. Levels of NT-proBNP in pleural fluid and serum correlated closely. Serum and pleural fluid NT-proBNP was significantly elevated in patients with cardiac effusion. With a cut-off value of 4000 ng·l-1, NT-proBNP levels in pleural fluid and serum displayed comparably high diagnostic accuracies of 92% and 91%, respectively. All patients misclassified by Light's criteria were correctly identified by measuring NT-proBNP.

NT-ProBNP levels in either pleural fluid or serum showed a high diagnostic accuracy when compared to the traditional criteria. Thus, measuring of NT-proBNP is a valuable additional diagnostic tool to detect or exclude cardiac origin of pleural effusions.

Keywords:  B-type natriuretic peptide, exudates and transudates, heart failure, pleural effusion




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