Development and validation of a diagnostic prediction model for heart failure-related pleural effusions: the BANCA score.

Aim: Heart failure (HF) is a common cause of pleural effusion (PE); however, its diagnosis can be challenging owing to overlapping clinical features with other causes. Measuring N-terminal pro-brain natriuretic peptide (NT-proBNP) levels is diagnostically useful, but the optimal cut-off point must be determined. This study aimed to optimise NT-proBNP cut-offs for diagnosing HF-related PEs and develop a scoring model to improve diagnostic precision. Methods: A retrospective analysis was conducted on 2005 patients with PEs, who were divided into derivation and validation cohorts. Receiver operating characteristic curve analysis identified the optimal cut-off point for NT-proBNP in pleural fluid and serum. A scoring system was developed based on logistic regression (TRIPOD statement) that included both clinical and laboratory variables. Its diagnostic accuracy was compared with that of existing methods using the area under the curve (AUC). Results: NT-proBNP ≥2500 pg·mL Conclusions: The BANCA score is a reliable tool for diagnosing HF-related PEs, offering superior accuracy compared with conventional methods. It is particularly useful for identifying cardiac effusions that are misclassified using traditional criteria.