Potential conflict of interest: Nothing to report.
Liver Failure/Cirrhosis/Portal Hypertension
Serum B-type natriuretic peptide in the initial workup of patients with new onset ascites: A diagnostic accuracy study
Article first published online: 13 JAN 2014
© 2014 by the American Association for the Study of Liver Diseases
Volume 59, Issue 3, pages 1043–1051, March 2014
How to Cite
Farias, A. Q., Silvestre, O. M., Garcia-Tsao, G., da Costa Seguro, L. F.B., de Campos Mazo, D. F., Bacal, F., Andrade, J. L., Gonçalves, L. L., Strunz, C., Ramos, D. S., Polli, D., Pugliese, V., Rodrigues, A. C.T., Furtado, M. S., Carrilho, F. J. and D'Albuquerque, L. A.C. (2014), Serum B-type natriuretic peptide in the initial workup of patients with new onset ascites: A diagnostic accuracy study. Hepatology, 59: 1043–1051. doi: 10.1002/hep.26643
This work was supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP; Sao Paulo Research Foundation; grant no.: 2011/09484-5).
- Issue published online: 25 FEB 2014
- Article first published online: 13 JAN 2014
- Accepted manuscript online: 2 AUG 2013 05:49AM EST
- Manuscript Accepted: 16 JUL 2013
- Manuscript Received: 19 APR 2013
Vol. 59, Issue 5, 2058, Article first published online: 23 APR 2014
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)