Cautious application of pleural N-terminal pro-B-type natriuretic peptide in diagnosis of congestive heart failure pleural effusions among critically ill patients
Journal
PLoS ONE
Journal Volume
9
Journal Issue
12
Pages
e115301
Date Issued
2014
Author(s)
Yeh J.-H.
Liu C.-H.
Tsai Y.-J.
HINT Study Group
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-pro-BNP 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. ? 2014 Yeh et al.
SDGs
Other Subjects
amino terminal pro brain natriuretic peptide; biological marker; brain natriuretic peptide; peptide fragment; pro-brain natriuretic peptide (1-76); acute kidney failure; adult; aged; Article; cohort analysis; congestive heart failure; controlled study; critically ill patient; diagnostic accuracy; female; high risk population; human; intensive care unit; major clinical study; male; pleura effusion; pleura fluid; prediction; prospective study; protein analysis; receiver operating characteristic; reference value; sensitivity and specificity; septic shock; thoracocentesis; critical illness; heart failure; metabolism; pathology; Pleural Effusion; Taiwan; very elderly; Aged; Aged, 80 and over; Biomarkers; Cohort Studies; Critical Illness; Female; Heart Failure; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Pleural Effusion; Prospective Studies; Taiwan
Publisher
Public Library of Science
Type
journal article