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Meta-Analysis
. 2010 Nov 20:10:58.
doi: 10.1186/1471-2466-10-58.

Diagnostic accuracy of pleural fluid NT-pro-BNP for pleural effusions of cardiac origin: a systematic review and meta-analysis

Surinder Janda  1 , John Swiston
Affiliations
Meta-Analysis

Diagnostic accuracy of pleural fluid NT-pro-BNP for pleural effusions of cardiac origin: a systematic review and meta-analysis

Surinder Janda et al. BMC Pulm Med. .

Abstract

Background: Several studies have been published in the literature on the diagnostic accuracy of NT-pro-BNP for pleural effusions from heart failure in the last decade. The purpose of our study was to perform a systematic review and meta-analysis on the diagnostic accuracy of pleural fluid NT-pro-BNP for pleural effusions of cardiac origin.

Methods: MEDLINE, EMBASE, PapersFirst, and the Cochrane collaboration and the Cochrane Register of controlled trials were searched. All searches were inclusive as of March 2010. Studies were only included if the absolute number of true-positive, false-negative, true-negative, and false-positive observations were available, and the "reference standards" were described clearly. Two investigators independently reviewed articles and extracted data. Quality was assessed with the Quality Assessment for Diagnostic Accuracy Studies (QUADAS). The bivariate model for diagnostic meta-analysis was used to obtain a pooled sensitivity and a pooled specificity.

Results: Ten studies (total number of patients 1120) were included in the meta-analysis. The average pleural fluid NT-pro-BNP level in effusions of cardiac origin was 6140 pg/mL. The pooled sensitivity and specificity of all studies combined was 94% (95% CI: 90-97) and 94% (95% CI: 89-97) respectively. The pooled positive likelihood ratio was 15.2 (95% CI: 8.1-28.7) and the pooled negative likelihood ratio was 0.06 (95% CI: 0.03-0.11). The area under the ROC curve was 0.98 (95% CI: 0.96-0.99) and the diagnostic odds ratio was 246 (95% CI: 81-745).

Conclusions: Pleural fluid NT-pro-BNP is a very useful biomarker with high diagnostic accuracy for distinguishing pleural effusions of cardiac origin.

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Figures

Figure 1
Figure 1
Flow chart of the studies included in the meta-analysis.
Figure 2
Figure 2
Proportion of all 14 Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool criteria that were fulfilled for seven of eight studies included in the meta-analysis.
Figure 3
Figure 3
Forrest plot of the sensitivity and specificity of each individual study, pooled sensitivity and specificity, and I2 statistic for heterogeneity.
Figure 4
Figure 4
Summary receiver operating characteristic graph with 95% confidence region and 95% prediction region for NT-pro-BNP.
Figure 5
Figure 5
Deeks' funnel plot asymmetry test for publication bias.
Figure 6
Figure 6
Fagan's nomogram for NT-pro-BNP illustrating post-test probability with a fixed pre-test probability of 20% for a pleural effusion of cardiac origin.
See this image and copyright information in PMC

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