Serum B-Type Natriuretic Peptide in the Initial Workup of Patients With New Onset Ascites: A Diagnostic Accuracy Study

Author(s):Show less -

Farias, Alberto Q. ^[1] ; Silvestre, Odilson M. ^[2] ; Garcia-Tsao, Guadalupe ^{[3, 4]} ; da Costa Seguro, Luis F. B. ^[2] ; de Campos Mazo, Daniel F. ^[1] ; Bacal, Fernando ^[2] ; Andrade, Jose L. ^[5] ; Goncalves, Luciana L. ^[6] ; Strunz, Celia ^[2] ; Ramos, Danusa S. ^[1] ; Polli, Demerson ^[7] ; Pugliese, Vincenzo ^[1] ; Rodrigues, Ana C. T. ^[5] ; Furtado, Meive S. ^[5] ; Carrilho, Flair J. ^[1] ; D'Albuquerque, Luiz A. C. ^[1]

Affiliation

^[1] Univ Sao Paulo, Sch Med, Dept Gastroenterol, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Inst Heart, Sch Med, Sao Paulo - Brazil

^[3] Yale Univ, Sect Digest Dis, West Haven, CT - USA

^[4] VA CT Healthcare Syst, West Haven, CT - USA

^[5] Univ Sao Paulo, Sch Med, Inst Radiol, Sao Paulo - Brazil

^[6] Univ Fed Espirito Santo, Vitoria, ES - Brazil

^[7] Univ Brasilia, Dept Stat, Brasilia, DF - Brazil

• Document type: Journal article
• Source: HEPATOLOGY; v. 59, n. 3, p. 1043-1051, MAR 2014.
• Web of Science Citations: 11

Abstract

Heart failure (HF) is, after cirrhosis, the second-most common cause of ascites. Serum B-type natriuretic peptide (BNP) plays an important role in the diagnosis of HF. Therefore, we hypothesized that BNP would be useful in the differential diagnosis of ascites. Consecutive patients with new onset ascites were prospectively enrolled in this cross-sectional study. All patients had measurements of serum-ascites albumin gradient (SAAG), total protein concentration in ascitic fluid, serum, and ascites BNP. We enrolled 218 consecutive patients with ascites resulting from HF (n = 44), cirrhosis (n = 162), peritoneal disease (n = 10), and constrictive pericarditis (n = 2). Compared to SAAG and/or total protein concentration in ascites, the test that best discriminated HF-related ascites from other causes of ascites was serum BNP. A cutoff of >364 pg/mL (sensitivity 98%, specificity 99%, and diagnostic accuracy 99%) had the highest positive likelihood ratio (168.1); that is, it was the best to rule in HF-related ascites. Conversely, a cutoff 182 pg/mL had the lowest negative likelihood ratio (0.0) and was the best to rule out HF-related ascites. These findings were confirmed in a 60-patient validation cohort. Conclusions: Serum BNP is more accurate than ascites analyses in the diagnosis of HF-related ascites. The workup of patients with new onset ascites could be streamlined by obtaining serum BNP as an initial test and could forego the need for diagnostic paracentesis, particularly in cases where the cause of ascites is uncertain and/or could be the result of HF. (Hepatology 2014;59:1043-1051) (AU)

• FAPESP's process: 11/09484-5 - B-type natriuretic peptide in the diagnosis of heart failure related ascites
• Grantee: Alberto Queiroz Farias
• Support Opportunities: Regular Research Grants