Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Dec 12;9(12):e115301.
doi: 10.1371/journal.pone.0115301. eCollection 2014.

Cautious application of pleural N-terminal pro-B-type natriuretic peptide in diagnosis of congestive heart failure pleural effusions among critically ill patients

Jiann-Horng Yeh  1 , Chun-Ta Huang  2 , Chia-Hsiung Liu  3 , Sheng-Yuan Ruan  4 , Yi-Ju Tsai  5 , Ying-Chun Chien  4 , Ching-Yao Yang  4 , Chun-Kai Huang  4 , Chia-Lin Hsu  4 , Lu-Cheng Kuo  4 , Pei-Lin Lee  4 , Shih-Chi Ku  4 , Ping-Hung Kuo  4 , Chong-Jen Yu  4 ; HINT Study Group
Affiliations

Cautious application of pleural N-terminal pro-B-type natriuretic peptide in diagnosis of congestive heart failure pleural effusions among critically ill patients

Jiann-Horng Yeh et al. PLoS One. .

Abstract

Background and objective: Several studies on diagnostic accuracy of pleural N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) for effusions from congestive heart failure (CHF) conclude that pleural NT-pro-BNP is a useful biomarker with high diagnostic accuracy for distinguishing CHF effusions. However, its applicability in critical care settings remains uncertain and requires further investigations.

Methods: NT-proBNP was measured in pleural fluid samples of a prospective cohort of intensive care unit patients with pleural effusions. Receiver operating characteristic curve analysis was performed to determine diagnostic accuracy of pleural NT-proBNP for prediction of CHF effusions.

Results: One hundred forty-seven critically ill patients were evaluated, 38 (26%) with CHF effusions and 109 (74%) with non-CHF effusions of various causes. Pleural NT-proBNP levels were significantly elevated in patients with CHF effusions. Pleural NT-pro-BNP demonstrated the area under the curve of 0.87 for diagnosing effusions due to CHF. With a cutoff of 2200 pg/mL, pleural NT-proBNP displayed high sensitivity (89%) but moderate specificity (73%). Notably, 29 (27%) of 109 patients with non-CHF effusions had pleural NT-proBNP levels >2200 pg/mL and these patients were more likely to experience septic shock (18/29 vs. 10/80, P<0.001) or acute kidney injury (19/29 vs. 9/80, P<0.001).

Conclusions: Among critically ill patients, pleural NT-proBNP measurements remain a useful diagnostic aid in evaluation of pleural effusions. However, patients with non-CHF effusions may exhibit high pleural NT-proBNP concentrations if they suffer from septic shock or acute kidney injury. Accordingly, it is suggested that clinical context should be taken into account when interpreting pleural NT-proBNP values in critical care settings.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Boxplots showing the minimum, 25th, 50th, and 75th percentiles, and the maximum pleural N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, by etiologies of pleural effusions.
Outliers (open circles) and extremes (stars) are plotted separately.
Figure 2
Figure 2. Receiver operating characteristic curve of pleural N-terminal pro-B-type natriuretic peptide levels comparing patients with pleural effusions caused by congestive heart failure to those with pleural effusions attributable to other reasons.
The area under the curve was 0.87 (95% confidence interval 0.81–0.92).
See this image and copyright information in PMC

References

    1. Light RW, Macgregor MI, Luchsinger PC, Ball WC Jr (1972) Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med 77:507–513. - PubMed
    1. Light RW (2002) Clinical practice. Pleural effusion. N Engl J Med 346:1971–1977. - PubMed
    1. Vives M, Porcel JM, Vicente de Vera M, Ribelles E, Rubio M (1996) A study of Light's criteria and possible modifications for distinguishing exudative from transudative pleural effusions. Chest 109:1503–1507. - PubMed
    1. Januzzi JL Jr, Camargo CA, Anwaruddin S, Baggish AL, Chen AA, et al. (2005) The N-terminal Pro-BNP investigation of dyspnea in the emergency department (PRIDE) study. Am J Cardiol 95:948–954. - PubMed
    1. Porcel JM, Vives M, Cao G, Esquerda A, Rubio M, et al. (2004) Measurement of pro-brain natriuretic peptide in pleural fluid for the diagnosis of pleural effusions due to heart failure. Am J Med 116:417–420. - PubMed

Publication types