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Original Research: PLEURAL DISEASE |

Comparison of Pleural Fluid N-Terminal Pro-Brain Natriuretic Peptide and Brain Natriuretic-32 Peptide Levels

Ann C. Long, MD; Hollis R. O’Neal, Jr, MD; Suiwei Peng, MD; Kirk B. Lane, PhD; Richard W. Light, MD, FCCP
Author and Funding Information

From the Department of Internal Medicine (Dr Long), Louisiana State University, Baton Rouge, LA; and the Division of Allergy, Pulmonary, and Critical Care Medicine (Drs O’Neal, Peng, Lane, and Light), Department of Medicine, Vanderbilt University, Nashville, TN.

Correspondence to: Ann C. Long, MD, Department of Internal Medicine, Louisiana State University, Earl K. Long Medical Center, 5825 Airline Hwy, Baton Rouge, LA, 70805; e-mail: along2@lsuhsc.edu


Funding/Support: This work was supported by the National Institutes of Health [Grant HL087738, Clinical and Transitional Research Training Grant]; and the Baton Rouge Area Foundation.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(6):1369-1374. doi:10.1378/chest.09-2193
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Background:  Current evidence indicates that measurement of pleural fluid N-terminal pro-brain natriuretic peptide (NT-proBNP) levels can aid in distinguishing pleural effusions of cardiac origin from those of noncardiac origin. To date, only one study, to our knowledge, has described simultaneous measurement of pleural fluid brain natriuretic-32 peptide (BNP) and NT-proBNP. The purpose of the present study was to determine pleural fluid BNP and NT-proBNP levels and analyze the relationship between these two measurements. We hypothesized that there would be a positive correlation between pleural fluid NT-proBNP and BNP, whereas NT-proBNP levels would be higher than BNP levels.

Methods:  Levels of pleural fluid NT-proBNP and BNP were measured by enzyme immunoassay in a total of 80 patients: 20 with congestive heart failure, 20 status post-coronary artery bypass graft, 20 with carcinoma, and 20 with pneumonia.

Results:  Comparison of NT-proBNP and BNP concentrations using the Spearman method of statistical analysis revealed a correlation coefficient of 0.572, P < .001. Evaluation of the diagnostic accuracy of BNP and NT-proBNP in patients with pleural effusions of cardiac origin demonstrated an area under the receiver operating characteristic curve of 0.700 (95% CI, 0.569-0.831) and 0.835 (95% CI, 0.721-0.949), respectively.

Conclusions:  Although levels of pleural fluid BNP have a statistically significant correlation with those of NT-proBNP, this relationship only explains 32% of the variance in NT-proBNP levels. Furthermore, when compared with BNP, NT-proBNP is a more accurate diagnostic aid in the evaluation of pleural effusions of cardiac origin.

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