Source: Annual Congress 2010 - Novel approach in diagnosis and treatment of pleural effusions
Disease area: Thoracic oncology

Abstract

NT-proBNP is a sensitive marker of cardiac dysfunction that can be measured in blood with a point-of-care ELISA. Its use in the diagnosis of a cardiac cause of exudative pleural effusion has been proposed. Previous series report impressive diagnostic characteristics but excluded patients with dual/unclear diagnoses and didn‘t select unilateral effusions alone. Aims:To prospectively examine the diagnostic utility of serum NT-proBNP in consecutive patients with an undiagnosed unilateral pleural effusion. Methods:Patients presenting to a UK teaching hospital underwent clinical assessment including ECG, echocardiogram, diagnostic pleural aspiration.Serum NT-proBNP was measured by point of care ELISA and result compared to final diagnosis. Patients were followed up to histological/microbiological diagnosis/radiographic resolution or for 12 months. Diagnosis was determined blind to NT-proBNP result Results:113 patients, median age 73 (28-96). 87 exudates, 17 transudates. Final diagnoses- cardiac 17/113, malignant 55/113, PE 4/113, benign 37/113. NT-proBNP cut-off at age and sex adjusted healthy population 95^th centile gave sensitivity 100%, specificity 54%, PPV 28%, NPV 100% for distinguishing a primary cardiac cause. At an optimum cut-off ≥1500 pg/mL sensitivity 82%, specificity 78%, PPV 40%, NPV 96%. 13/55(24%) malignant effusions had NT-proBNP ≥ 1500pg/mL. Conclusion: The utility of NT-proBNP in the initial investigation of unilateral pleural effusions is limited by high levels of co-existent cardiac disease in patients with non-cardiac effusions. A high result cannot be used to avoid invasive tests but its high NPV may be useful to rule out a cardiac cause in selected cases.

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Citations should be made in the following way:
C. E. Hooper, I. Rider, R. S. Finn, A. J. Morley, J. E. Harvey, A. Skyrme-Jones, N. A. Maskell (Bristol, United Kingdom). Clinical utility of serum NT-proBNP in the investigation of undiagnosed unilateral pleural effusions. Eur Respir J 2010; 36: Suppl. 54, 224

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