Chest
Original ResearchPleural EffusionBiomarkers of Heart Failure in Pleural Fluid
Section snippets
Materials and Methods
We performed a retrospective analysis of patients with pleural effusion from a prospectively maintained database. To do so, we selected 86 consecutive patients from a previous prospective study6 (50 patients with HF and 36 patients with noncardiac effusions), adding 95 newer patients (40 patients with HF and 55 patients with noncardiac effusions) who had been entered into our computerized database from the periods 2001 to 2004 and 2007 to 2008. In this latter group, the selected patients with
Patients' Characteristics and Distribution of Biomarker Concentrations in Pleural Effusions
We analyzed pleural fluid samples from 90 patients with HF and 91 patients with noncardiac effusions, including 10 hepatic hydrothoraces, 40 malignant effusions, 15 parapneumonic effusions, 11 tuberculous effusions, and 15 miscellaneous exudate effusions (pulmonary embolism, 12 patients; hemothorax, 1 patient; Dressler syndrome, 1 patient; and drug-induced pleural disease, 1 patient). Table 1 lists the characteristics of these two groups. As expected, the patients with HF were of advanced age
Discussion
In this study, three quantitative markers of cardiac stress,4 namely NT-pro-BNP, BNP, and ST2, were measured in pleural fluid, and their concentrations were found to be higher among patients with HF than among those with noncardiac effusions. This is the first report on the use of pleural fluid BNP and ST2 concentrations to determine the cardiac origin of a pleural effusion. On comparing the accuracy of all three tests, the levels of pleural fluid NT-pro-BNP revealed significantly better
Acknowledgments
Author contributions: Conception and design: Drs. Porcel and Esquerda, Ms. Martínez-Alonso. Analysis and interpretation of the data: Ms. Martínez-Alonso and Dr. Bielsa. Drafting of the article: Dr. Porcel. Critical revision of the article for important intellectual content: Drs. Porcel, Cao, Bielsa, Sopena, and Esquerda, and Ms. Martínez-Alonso. Final approval of the article: Drs. Porcel, Cao, Bielsa, Sopena, and Esquerda, and Ms. Martínez-Alonso. Statistical expertise: Ms. Martínez-Alonso.
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Pleural Fluid Analysis: Are Light's Criteria Still Relevant After Half a Century?
2021, Clinics in Chest MedicineCitation Excerpt :The most widely used cutoff point is 1500 pg/mL,69,70 though with the advent of more sensitive new generation tests this threshold needs to be reevaluated. NT-proBNP is a more useful biomarker of HF than BNP when measured in PF,70 but it has similar discriminating capabilities as midregion pro-atrial natriuretic peptide.71 In addition, NT-proBNP concentrations allow clinicians to correctly identify greater than 80% of those cardiac PEs misclassified as exudates by Light’s criteria.70
Update in the Management of Pleural Effusions
2019, Medical Clinics of North AmericaDevelopment and validation of a scoring system for the identification of pleural exudates of cardiac origin
2018, European Journal of Internal MedicinePleural effusion: Diagnosis and management
2015, Revue de Medecine InternePleural Effusion
2015, Murray and Nadel's Textbook of Respiratory Medicine: Volume 1,2, Sixth EditionImproving the predictive accuracy of identifying exudative effusions
2014, ChestCitation Excerpt :Romero-Candeira and colleagues17 showed that in patients who received diuretic therapy, the SF-A and SF-P gradients had higher rates of correctly identifying misclassified transudates but similar accuracy when compared with Light's criteria. We did not measure pleural fluid N-terminal pro-brain natriuretic peptide, a biomarker that has been used in identifying misclassified CHF transudates by Light's criteria but does not add additional information to a serum brain natriuretic peptide determination.21,22 Given its retrospective design, missing data were also a limitation in our study, as they reduced the proportion of patients for whom both gradients could be calculated.
Funding/Support: Dr. Bielsa is supported by a grant from the Fondo de Investigación Sanitaria (FIS CM07/00020), Instituto de Salud Carlos III, Madrid, Spain.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).