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Egyptian Journal of Chest Diseases and Tuberculosis [The]. 2012; 61 (3): 109-114
in English | IMEMR | ID: emr-160104

ABSTRACT

The finding of an exudative effusion usually requires an extensive diagnostic workup, leading to an unnecessary exposure to invasive and expensive diagnostic procedures. Thus a strategy of identifying pleural effusions due to heart failure and possibly avoiding unnecessary diagnostic thoracentesis and/or further diagnostic procedures would be an attractive and potentially beneficial approach [6]. NT-proBNP measured in serum is a sensitive marker of cardiac dysfunction and proven to be a useful tool in the diagnosis of acute and chronic systolic and diastolic left ventricular heart failure [7, 8]. The present study was conducted to assess the diagnostic value of NT-proBNP in the differentiation of cardiogenic and non cardiogenic pleural effusion. Forty patients with pleural effusion were included in this study. Twenty patients with cardiogenic pleural effusions [pleural effusion due to cardiac cause] and 20 patients with non cardiogenic pleural effusions [pleural effusion due to non cardiac cause]. All patients were subjected to full history, clinical examination, investigation to detect the etiology of the pleural effusion and measurement of serum and pleural fluid NT-proBNP. In this study we found that pleural fluid NT-proBNP levels were significantly higher in patients with cardiogenic pleural effusions than that of patients with non cardiogenic pleural effusions [Mean +/- SEM, 5231 +/- 671.1 and 628.8 +/- 120.1 respectively, P value < 0.0001]. Also NT-proBNP levels in the serum of the patients with cardiogenic pleural effusions were significantly higher than that of patients with non cardiogenic pleural effusions [Mean +/- SEM, 4792 +/- 612.7, and 604.0 +/- 120.1 respectively, P value < 0.0001]. There was also a highly significant positive correlation between NT-proBNP levels in serum and pleural fluid Spearman's Coefficient of rank correlation is 0.992 [p < 0.0001]. We found also that at a cut-off value of 1.591 pg/ml, pleural fluid NT-proBNP level had a sensitivity of 95% and a specificity of 90% in the diagnosis of cardiogenic pleural effusion. Also at a cut off value of 1570 pg/ml, serum NT-proBNP level had a sensitivity of 95% and a specificity of 90% in the diagnosis of cardiogenic pleural effusion. It is concluded that serum and pleural fluid NT-proBNP levels are very useful in establishing the diagnosis of cardiogenic pleural effusions


Subject(s)
Humans , Male , Female , Pleural Effusion/complications , Heart Failure/complications , Hospitals, University
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