<p>Prognostic Role of NT-proBNP for in-Hospital and 1-Year Mortality in Patients with Acute Exacerbations of COPD</p>

Abstract

Background and objective: The association between N-terminal pro B-type natriuretic peptide (NT-proBNP) concentrations and in-hospital and 1-year mortality in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients is largely unknown. Our objective was to explore the usefulness of NT-proBNP concentrations in AECOPD patients as a prognostic marker for in-hospital and 1-year mortality. Methods: NT-proBNP levels were measured in patients upon admission and laboratory and clinical data were also recorded. The cut-point for the NT-proBNP concentration level for inhospital death was obtained using the receiver operating characteristic (ROC) curve. Univariate and multivariate logistic regression and Cox regression were used in the analyses of factors of inhospital and 1-year mortality. Results: A total of 429 patients were enrolled. Twenty-nine patients died during hospitalization and 59 patients died during the 1-year follow-up. Patients who died in-hospital compared with those in-hospital survivors were older (80.14±6.56 vs 75.93±9.45 years, p=0.003), had a higher percentage of congestive heart failure (65.52% vs 33.75%, p<0.001), had higher NT-proBNP levels (5767.00 (1372.50-12,887.00) vs 236.25 (80.03-1074.75) ng/L, p<0.001), higher neutrophil counts (10.52±5.82 vs 7.70±4.31, p=0.016), higher D-dimer levels (1231.62±1921.29 vs 490.11±830.19, p=0.048), higher blood urea nitrogen levels (9.91±6.33 vs 6.51±4.01 mmol/L, p=0.001), a lower body mass index (19.49±3.57 vs 22.19±4.76, p=0.003), and higher hemoglobin levels (122.34 ±25.36 vs 130.57±19.63, p=0.034). The area under the ROC curve (AUC) for NT-proBNP concentration was 0.88 (95% confidence interval [CI], 0.84-0.93). NT-proBNP concentrations ≥551.35 ng/L were an independent prognostic factor for both in-hospital and 1-year mortality after adjustment for relative risk (RR) (RR=29.54, 95% CI 3.04-286.63, p=0.004 for the multivariate logistic regression analysis) and hazard ratio (HR) (HR=4.47, 95% CI, 2.38-8.41, p <0.001 for the multivariate cox regression analysis). Conclusion: NT-proBNP was a strong and independent predictor of in-hospital and 1-year mortality in AECOPD patients.

Heart Failure is Highly Prevalent and Difficult to Diagnose in Severe Exacerbations of COPD Presenting to the Emergency Department

“…The RW admission diagnostic procedures including cardiac echo revealed the high frequency of cardiac failure as a cause for the acute deterioration of respiratory symptoms in these patients. None of the cardiac complication that have been reported to occur in AECOPD after admission, such as myocardial infarction or arrhythmias [11,24], occurred in our population, which confirms that cardiac failure, when present, was part of the presenting AECOPD. Several mechanisms such as tachycardia, hypoxemia, increased pulmonary artery pressure, infective exacerbations provoking arterial stiffness have been postulated as causing cardiac distress during AECOPD in subjects with associated cardiac disease [25,26].…”

“…The strong association of underlying cardiovascular comorbidities in any degree of COPD severity suggests that ED management should always include a workup for potential associated cardiovascular events. A high degree of suspicion, past history of cardiovascular diseases, ECG and NT-proBNP, a valuable tool in the diagnosis of HF, are recommended steps to reach a diagnosis of HF, yet it will still be difficult in the presence of COPD [13,24]. In our cohort, the results of NT-proBNP and CRP done during the RW admission, where heart failure was confirmed by the echocardiogram, were similar to the ones done in the ED.…”

Association Between the Level of Plasma B-type Natriuretic Peptide and in-hospital Mortality in Patients With Acute Exacerbation of COPD&nbsp;Without a History of Coronary Ischemic Heart Disease: A Retrospective Study

“…[10] Another study by Hai et al found that NT-pro-BNP level (≥551.35 ng/l) was associated with in-hospital mortality and 1-year mortality in patients with exacerbations of COPD, but in their study, about 35.9% of patients had congestive heart failure. [11] A systematic review and meta-analysis also found that elevated NT-pro-BNP values were associated with all-cause in-hospital mortality in patients with and without exacerbation of COPD. [17] Stolz et al found that BNP was not associated with 6-month or 2-year mortality in patients with exacerbations of COPD, but BNP accurately predicted the need for ICU treatment, and the need for mechanical ventilation was the most common reasons for ICU admission.…”

“…[10] Another prospective study showed that NT-pro-BNP level was associated with in-hospital mortality and 1-year mortality in patients with exacerbations of COPD; however, in their studies, about 35.9% of patients had congestive heart failure. [11] Stolz et al found that BNP accurately predicted the need for intensive care unit (ICU) treatment, [12] and BNP was an independent predictor of requirement for noninvasive ventilation, mechanical ventilation, and noninvasive ventilation failure in patients with AECOPD along with preserved left ventricular function. [13] However, some studies have found that NT-pro-BNP level was not associated with the requirement for noninvasive positive pressure ventilation, mechanical ventilation, or in-hospital mortality in patients with AECOPD without underlying left ventricular dysfunction.…”

Clinical value of IL-13 and ECP in the serum and sputum of eosinophilic AECOPD patients

“…2 In recent years, a large number of studies have found that EOS also participates in chronic obstructive pulmonary airway inflammation, so eosinophilic AECOPD is of wide concern in the respiratory community. 3,4 IL-13 and ECP are both cytokines related to EOS inflammation. A large number of animal experiments and clinical studies have shown that both IL-13 and ECP are involved in the pathogenesis of COPD.…”