Zalts Ronen, Twizer Tomer, Leiba Ronit, Karban Amir
Department of Internal Medicine C, Rambam Health Care Campus, Haifa, affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Department of Quality of Care Unit, Rambam Health Care Campus, Haifa, affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Isr Med Assoc J. 2018 May;20(5):304-307.
The identification of the etiology of a pleural effusion can be difficult. Measurement of serum B-type natriuretic peptide (BNP) levels is helpful in the diagnosis of congestive heart failure (CHF) as a cause of respiratory failure, but pleural fluid BNP measurement is still not part of the workup for pleural effusion.
To identify the correlation between pleural fluid BNP levels and clinical diagnosis.
In this cross-sectional study, data from 107 patients admitted to the department of internal medicine between November 2009 and January 2015 were obtained from medical records. Patients underwent a diagnostic thoracocentesis as part of their evaluation. They were grouped according to final diagnosis at discharge and clinical judgment of the attending physician.
Serum BNP levels were significantly higher in the CHF patients compared to patients with non-cardiac causes of pleural effusion (1519.2 and 314.1 respectively, P < 0.0001). Mean pleural fluid BNP was also significantly higher in the CHF patients (1063.2 vs. 208.3, P < 0.0001). Optional cutoff points to distinguish between cardiac and non-cardiac etiology of pleural effusion were 273.4 pg/ml (sensitivity 83.3%, specificity 72.3%, accuracy 76.7%) or 400 pg/ml (sensitivity 78.6%, specificity 86.2%, accuracy 83.0%). A strong correlation was found between serum BNP and pleural fluid BNP levels.
High levels of serum BNP in patients presenting with pleural effusion suggest CHF. In cases with doubt regarding the etiology of pleural effusion, high levels of pleural fluid BNP can support the diagnosis, but are not superior to serum BNP levels.
确定胸腔积液的病因可能具有挑战性。测量血清B型利钠肽（BNP）水平有助于诊断作为呼吸衰竭病因的充血性心力衰竭（CHF），但胸腔积液BNP测量仍不是胸腔积液检查的一部分。
确定胸腔积液BNP水平与临床诊断之间的相关性。
在这项横断面研究中，从2009年11月至2015年1月内科收治的107例患者的病历中获取数据。患者接受诊断性胸腔穿刺术作为评估的一部分。根据出院时的最终诊断和主治医生的临床判断对他们进行分组。
与非心脏原因引起胸腔积液的患者相比，CHF患者的血清BNP水平显著更高（分别为1519.2和314.1，P<0.0001）。CHF患者的平均胸腔积液BNP也显著更高（1063.2对208.3，P<0.0001）。区分胸腔积液心脏和非心脏病因的最佳截断点为273.4 pg/ml（敏感性83.3%，特异性72.3%，准确性76.7%）或400 pg/ml（敏感性78.6%，特异性86.2%，准确性83.0%）。血清BNP与胸腔积液BNP水平之间存在强相关性。
胸腔积液患者血清BNP水平高提示CHF。在胸腔积液病因存疑的病例中，高胸腔积液BNP水平可支持诊断，但并不优于血清BNP水平。
