Diagnostic accuracy of serum NT-proBNP for pleural effusions due to congestive heart failure: a systematic review and updated meta-analysis.
Source: PubMed, NCBI / U.S. National Library of Medicine
Several studies have investigated the diagnostic value of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) for congestive heart failure (CHF) in patients with undiagnosed pleural effusion, but results remain inconsistent. This systematic review aimed to determine the diagnostic accuracy of serum NT-proBNP levels in CHF-related effusions. PubMed and Web of Science databases were searched for eligible studies investigating the accuracy of serum NT-proBNP in diagnosing CHF-related pleural effusions until March 1, 2025. We used a bivariate model to calculate the pooled sensitivity and specificity. The overall diagnostic accuracy was evaluated using a summary receiver operating characteristic (sROC) curve. We compared the accuracy of serum and pleural fluid NT-proBNP levels in studies evaluating both. Study quality was assessed using the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Seven studies, including 1098 patients with and 1114 without CHF-related pleural effusion, were included. Serum NT-proBNP's pooled sensitivity and specificity for diagnosing CHF-related pleural effusion were 0.83 (95% CI: 0.75-0.88) and 0.84 (95% CI: 0.75-0.91). The positive likelihood ratio was 5.3 (95% CI: 3.2-8.8), negative likelihood ratio 0.20 (95% CI: 0.14-0.31), diagnostic odds ratio 26 (95% CI: 12-56), and area under the sROC curve 0.90 (95% CI: 0.87-0.92). No publication bias was detected. A head-to-head comparison of five studies showed that the area under th
Abstract
Several studies have investigated the diagnostic value of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) for congestive heart failure (CHF) in patients with undiagnosed pleural effusion, but results remain inconsistent. This systematic review aimed to determine the diagnostic accuracy of serum NT-proBNP levels in CHF-related effusions. PubMed and Web of Science databases were searched for eligible studies investigating the accuracy of serum NT-proBNP in diagnosing CHF-related pleural effusions until March 1, 2025. We used a bivariate model to calculate the pooled sensitivity and specificity. The overall diagnostic accuracy was evaluated using a summary receiver operating characteristic (sROC) curve. We compared the accuracy of serum and pleural fluid NT-proBNP levels in studies evaluating both. Study quality was assessed using the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Seven studies, including 1098 patients with and 1114 without CHF-related pleural effusion, were included. Serum NT-proBNP's pooled sensitivity and specificity for diagnosing CHF-related pleural effusion were 0.83 (95% CI: 0.75-0.88) and 0.84 (95% CI: 0.75-0.91). The positive likelihood ratio was 5.3 (95% CI: 3.2-8.8), negative likelihood ratio 0.20 (95% CI: 0.14-0.31), diagnostic odds ratio 26 (95% CI: 12-56), and area under the sROC curve 0.90 (95% CI: 0.87-0.92). No publication bias was detected. A head-to-head comparison of five studies showed that the area under the curve (AUC) of serum and pleural fluid NT-proBNP for labeling CHF was similar. Serum NT-proBNP level shows good diagnostic accuracy for CHF-related pleural effusions, with diagnostic performance comparable to that of pleural fluid NT-proBNP level.