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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

Forest plot of the estimates of sensitivity and specificity for pleural fluid N-terminal pro-brain natriuretic peptide in the diagnosis of heart failure.
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pone.0134376.g002: Forest plot of the estimates of sensitivity and specificity for pleural fluid N-terminal pro-brain natriuretic peptide in the diagnosis of heart failure.

Mentions: Because the diagnostic accuracy of blood BNP, PF BNP, and PF MR-proANP for HF was investigated in only two, three, and one study, respectively, we only evaluated the diagnostic accuracy of PF and blood NT-proBNP for HF in the present meta-analysis. These results are presented in Table 4. The overall sensitivity and specificity of PF NT-proBNP for diagnosis of HF were 0.94 and 0.91, respectively. The I2 for sensitivity and specificity were 60.22 (95% confidence interval [CI]: 35.04–85.40) and 89.13 (95% CI: 84.23–94.03), respectively. Bivariate model analysis showed that this heterogeneity was completely (100%) explained by the threshold effect. Fig 2 graphically depicts the overall diagnostic sensitivity and specificity as well as the heterogeneity across all 12 studies that investigated the diagnostic accuracy of PF NT-proBNP for HF. The overall sensitivity and specificity of blood NT-proBNP for diagnosis of HF were 0.92 and 0.88, respectively. The I2 for sensitivity and specificity were 17.48 (95% CI: 0.00–100.00) and 94.58 (95%CI: 90.85–98.32), respectively. Bivariate model analysis also showed that this heterogeneity was completely (100%) explained by the threshold effect. Considering that the heterogeneity across the studies could be completely explained by the threshold effect, neither subgroup analysis nor meta-regression was performed.


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)

Forest plot of the estimates of sensitivity and specificity for pleural fluid N-terminal pro-brain natriuretic peptide in the diagnosis of heart failure.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0134376.g002: Forest plot of the estimates of sensitivity and specificity for pleural fluid N-terminal pro-brain natriuretic peptide in the diagnosis of heart failure.
Mentions: Because the diagnostic accuracy of blood BNP, PF BNP, and PF MR-proANP for HF was investigated in only two, three, and one study, respectively, we only evaluated the diagnostic accuracy of PF and blood NT-proBNP for HF in the present meta-analysis. These results are presented in Table 4. The overall sensitivity and specificity of PF NT-proBNP for diagnosis of HF were 0.94 and 0.91, respectively. The I2 for sensitivity and specificity were 60.22 (95% confidence interval [CI]: 35.04–85.40) and 89.13 (95% CI: 84.23–94.03), respectively. Bivariate model analysis showed that this heterogeneity was completely (100%) explained by the threshold effect. Fig 2 graphically depicts the overall diagnostic sensitivity and specificity as well as the heterogeneity across all 12 studies that investigated the diagnostic accuracy of PF NT-proBNP for HF. The overall sensitivity and specificity of blood NT-proBNP for diagnosis of HF were 0.92 and 0.88, respectively. The I2 for sensitivity and specificity were 17.48 (95% CI: 0.00–100.00) and 94.58 (95%CI: 90.85–98.32), respectively. Bivariate model analysis also showed that this heterogeneity was completely (100%) explained by the threshold effect. Considering that the heterogeneity across the studies could be completely explained by the threshold effect, neither subgroup analysis nor meta-regression was performed.

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