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- Title
Comparison of pleural N-terminal pro- B-type natriuretic peptide, midregion pro-atrial natriuretic peptide and mid-region pro-adrenomedullin for the diagnosis of pleural effusions associated with cardiac failure.
- Authors
Porcel, José M.; Bielsa, Silvia; Morales‐Rull, José L.; Civit, Carme; Cao, Gonzalo; Light, Richard W.; Esquerda, Aureli
- Abstract
Background and objective The purpose of this study was to compare the diagnostic utility of pleural fluid N-terminal pro- B-type natriuretic peptide ( NT-pro BNP), midregion pro-atrial natriuretic peptide ( MR-pro ANP) and midregion pro-adrenomedullin ( MR-pro ADM) for discriminating heart failure ( HF)-associated effusions. Methods NT-pro BNP, MR-pro ANP and MR-pro ADM were measured by commercially available methodologies in the pleural fluid of a retrospective cohort of 185 consecutive patients with pleural effusions, of whom 95 had acute decompensated HF. Receiver-operating characteristic and area under the curve ( AUC) analyses allowed comparisons of the discriminative properties of these biomarkers to be made at their optimal cut-off points. Results The diagnostic accuracy of NT-pro BNP and MR-pro ANP for HF as quantified by the AUC was 0.935 and 0.918, respectively, whereas MR-pro ADM was of limited value ( AUC = 0.62). A pleural fluid MR-pro ANP >260 pmol/ L or NT-pro BNP >1700 pg/ mL argues for HF (likelihood ratio ( LR) positive >5), while levels below these cut-off values significantly decrease the probability of having the disease (respective LR negative 0.19 and 0.10). The optimal cut-off points for natriuretic peptides were influenced by age, renal function and body mass index. Finally, both NT-pro BNP and the albumin gradient correctly identified more than 80% of those cardiac effusions misclassified as exudates by standard criteria. Conclusions MR-pro ANP is as valuable a diagnostic tool as NT-pro BNP for diagnosing or excluding HF as the cause of pleural effusion.
- Subjects
NATRIURETIC peptides; ADRENOMEDULLIN; PLEURAL effusions; HEART failure risk factors; GLOMERULAR filtration rate; CONFIDENCE intervals; DIAGNOSIS
- Publication
Respirology, 2013, Vol 18, Issue 3, p540
- ISSN
1323-7799
- Publication type
Article
- DOI
10.1111/resp.12039