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Diagnostic Accuracy of Natriuretic Peptides for Heart Failure in Patients with Pleural Effusion: A Systematic Review and Updated Meta-Analysis.

Han ZJ, Wu XD, Cheng JJ, Zhao SD, Gao MZ, Huang HY, Gu B, Ma P, Chen Y, Wang JH, Yang CJ, Yan ZH - PLoS ONE (2015)

Bottom Line: Previous studies have reported that natriuretic peptides in the blood and pleural fluid (PF) are effective diagnostic markers for heart failure (HF).The diagnostic accuracy of PF MR-proANP and blood and PF BNP was not analyzed due to the small number of related studies.Additional studies are needed to rigorously evaluate the diagnostic accuracy of PF and blood MR-proANP and BNP for the diagnosis of HF.

View Article: PubMed Central - PubMed

Affiliation: Department of Laboratory Medicine, Wuxi Second People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China; Department of Laboratory Medicine, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu, China.

ABSTRACT

Background: Previous studies have reported that natriuretic peptides in the blood and pleural fluid (PF) are effective diagnostic markers for heart failure (HF). These natriuretic peptides include N-terminal pro-brain natriuretic peptide (NT-proBNP), brain natriuretic peptide (BNP), and midregion pro-atrial natriuretic peptide (MR-proANP). This systematic review and meta-analysis evaluates the diagnostic accuracy of blood and PF natriuretic peptides for HF in patients with pleural effusion.

Methods: PubMed and EMBASE databases were searched to identify articles published in English that investigated the diagnostic accuracy of BNP, NT-proBNP, and MR-proANP for HF. The last search was performed on 9 October 2014. The quality of the eligible studies was assessed using the revised Quality Assessment of Diagnostic Accuracy Studies tool. The diagnostic performance characteristics (sensitivity, specificity, and other measures of accuracy) were pooled and examined using a bivariate model.

Results: In total, 14 studies were included in the meta-analysis, including 12 studies reporting the diagnostic accuracy of PF NT-proBNP and 4 studies evaluating blood NT-proBNP. The summary estimates of PF NT-proBNP for HF had a diagnostic sensitivity of 0.94 (95% confidence interval [CI]: 0.90-0.96), specificity of 0.91 (95% CI: 0.86-0.95), positive likelihood ratio of 10.9 (95% CI: 6.4-18.6), negative likelihood ratio of 0.07 (95% CI: 0.04-0.12), and diagnostic odds ratio of 157 (95% CI: 57-430). The overall sensitivity of blood NT-proBNP for diagnosis of HF was 0.92 (95% CI: 0.86-0.95), with a specificity of 0.88 (95% CI: 0.77-0.94), positive likelihood ratio of 7.8 (95% CI: 3.7-16.3), negative likelihood ratio of 0.10 (95% CI: 0.06-0.16), and diagnostic odds ratio of 81 (95% CI: 27-241). The diagnostic accuracy of PF MR-proANP and blood and PF BNP was not analyzed due to the small number of related studies.

Conclusions: BNP, NT-proBNP, and MR-proANP, either in blood or PF, are effective tools for diagnosis of HF. Additional studies are needed to rigorously evaluate the diagnostic accuracy of PF and blood MR-proANP and BNP for the diagnosis of HF.

No MeSH data available.


Related in: MedlinePlus

Flow chart illustrating the systematic literature search and study selection process.
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pone.0134376.g001: Flow chart illustrating the systematic literature search and study selection process.

Mentions: In total, 14 studies involving 599 patients with HF and 1055 patients without HF were included in the present work [25–38]. A flow chart depicting the study selection process is shown in Fig 1. A summary of the most pertinent details of the eligible studies is shown in Table 1. The sample size of these 14 studies ranged from 28 to 398. Half of the studies were prospective [25, 27, 32, 34–36, 38], five were retrospective [26, 28–31], and the remaining two did not report their design characteristics [33, 37]. The control groups generally comprised patients with malignancy, tuberculosis, parapneumonic effusion, pulmonary embolism, hepatic hydrothorax, postcardiac injury syndrome, collagen disease, and other conditions.


Diagnostic Accuracy of Natriuretic Peptides for Heart Failure in Patients with Pleural Effusion: A Systematic Review and Updated Meta-Analysis.

Han ZJ, Wu XD, Cheng JJ, Zhao SD, Gao MZ, Huang HY, Gu B, Ma P, Chen Y, Wang JH, Yang CJ, Yan ZH - PLoS ONE (2015)

Flow chart illustrating the systematic literature search and study selection process.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4526570&req=5

pone.0134376.g001: Flow chart illustrating the systematic literature search and study selection process.
Mentions: In total, 14 studies involving 599 patients with HF and 1055 patients without HF were included in the present work [25–38]. A flow chart depicting the study selection process is shown in Fig 1. A summary of the most pertinent details of the eligible studies is shown in Table 1. The sample size of these 14 studies ranged from 28 to 398. Half of the studies were prospective [25, 27, 32, 34–36, 38], five were retrospective [26, 28–31], and the remaining two did not report their design characteristics [33, 37]. The control groups generally comprised patients with malignancy, tuberculosis, parapneumonic effusion, pulmonary embolism, hepatic hydrothorax, postcardiac injury syndrome, collagen disease, and other conditions.

Bottom Line: Previous studies have reported that natriuretic peptides in the blood and pleural fluid (PF) are effective diagnostic markers for heart failure (HF).The diagnostic accuracy of PF MR-proANP and blood and PF BNP was not analyzed due to the small number of related studies.Additional studies are needed to rigorously evaluate the diagnostic accuracy of PF and blood MR-proANP and BNP for the diagnosis of HF.

View Article: PubMed Central - PubMed

Affiliation: Department of Laboratory Medicine, Wuxi Second People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China; Department of Laboratory Medicine, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu, China.

ABSTRACT

Background: Previous studies have reported that natriuretic peptides in the blood and pleural fluid (PF) are effective diagnostic markers for heart failure (HF). These natriuretic peptides include N-terminal pro-brain natriuretic peptide (NT-proBNP), brain natriuretic peptide (BNP), and midregion pro-atrial natriuretic peptide (MR-proANP). This systematic review and meta-analysis evaluates the diagnostic accuracy of blood and PF natriuretic peptides for HF in patients with pleural effusion.

Methods: PubMed and EMBASE databases were searched to identify articles published in English that investigated the diagnostic accuracy of BNP, NT-proBNP, and MR-proANP for HF. The last search was performed on 9 October 2014. The quality of the eligible studies was assessed using the revised Quality Assessment of Diagnostic Accuracy Studies tool. The diagnostic performance characteristics (sensitivity, specificity, and other measures of accuracy) were pooled and examined using a bivariate model.

Results: In total, 14 studies were included in the meta-analysis, including 12 studies reporting the diagnostic accuracy of PF NT-proBNP and 4 studies evaluating blood NT-proBNP. The summary estimates of PF NT-proBNP for HF had a diagnostic sensitivity of 0.94 (95% confidence interval [CI]: 0.90-0.96), specificity of 0.91 (95% CI: 0.86-0.95), positive likelihood ratio of 10.9 (95% CI: 6.4-18.6), negative likelihood ratio of 0.07 (95% CI: 0.04-0.12), and diagnostic odds ratio of 157 (95% CI: 57-430). The overall sensitivity of blood NT-proBNP for diagnosis of HF was 0.92 (95% CI: 0.86-0.95), with a specificity of 0.88 (95% CI: 0.77-0.94), positive likelihood ratio of 7.8 (95% CI: 3.7-16.3), negative likelihood ratio of 0.10 (95% CI: 0.06-0.16), and diagnostic odds ratio of 81 (95% CI: 27-241). The diagnostic accuracy of PF MR-proANP and blood and PF BNP was not analyzed due to the small number of related studies.

Conclusions: BNP, NT-proBNP, and MR-proANP, either in blood or PF, are effective tools for diagnosis of HF. Additional studies are needed to rigorously evaluate the diagnostic accuracy of PF and blood MR-proANP and BNP for the diagnosis of HF.

No MeSH data available.


Related in: MedlinePlus