NT-proBNP in Different Patient Groups of COPD: A Systematic Review and Meta-Analysis

Abstract

Purpose NT-proBNP, a peptide biomarker synthesized and secreted by cardiomyocytes in response to cardiac load, has gained attention in recent years for its potential role in respiratory diseases. Chronic Obstructive Pulmonary Disease (COPD), a chronic and progressive inflammatory condition affecting the respiratory system, is frequently associated with comorbidities involving the cardiovascular system. Consequently, the aim of this systematic review and meta-analysis was to evaluate the variations in NT-proBNP levels across distinct patient groups with COPD and establish a foundation for future investigations into the precise clinical significance of NT-proBNP in COPD. Methods The search databases for this study were conducted in PubMed, Excerpt Medica database (Embase), Web of Science (WOS), and Cochrane Library databases. Databases were searched for studies on the predictive value of NT-proBNP in adult COPD patients. Results A total of 29 studies (8534 participants) were included. Patients with stable COPD exhibit elevated levels of NT-proBNP [standardized mean difference(SMD) [95CI%]=0.51 [0.13,0.89]; p =0.0092]. COPD patients with predicted forced expiratory volume in 1 s (FEV 1 ) < 50% exhibit significantly elevated levels of NT-proBNP compared to those with FEV 1 ⩾50%[SMD [95CI%]=0.17 [0.05,0.29]; p =0.0058]. NT-proBNP levels were significantly higher in acute exacerbations (AECOPD) compared to patients with stable COPD [SMD [95CI%]=1.18 [0.07,2.29]; p =0.037]. NT-proBNP levels was significantly higher in non-survivors than in survivors of hospitalised AECOPD patients [SMD [95CI%]=1.67 [0.47,2.88]; p =0.0063]. Both COPD patients with pulmonary hypertension(PH) [SMD [95CI%]=0.82 [0.69,0.96]; p <0.0001] and chronic heart failure(CHF) [SMD [95CI%]=1.49 [0.96,2.01]; p <0.0001] showed higher NT-proBNP level. Conclusion NT-proBNP, a biomarker commonly used in clinical practice to evaluate cardiovascular disease, demonstrates significant variations in different stages of COPD and during the progression of the disease. The fluctuations in NT-proBNP levels could be indicative of the severity of pulmonary hypoxia and inflammation and cardiovascular stress among COPD patients. Therefore, assessing NT-proBNP levels in COPD patients can aid in making informed clinical decisions.

Lack of Evidence Regarding Markers Identifying Acute Heart Failure in Patients with COPD: An AI-Supported Systematic Review

“…2 To illustrate, two studies evaluated NT-proBNP in terms of sensitivity, specificity and predictive values, but used different cut-off values. 27 , 39 Given that levels of BNP and NT-proBNP are already elevated in stable COPD patients, 16 , 17 during an AECOPD, 4 , 43 and in the elderly with COPD, 4 , 27 , 43 it would be advisable to apply higher cut-off values for the differential diagnosis of acute dyspnea in these patients. Before the AHF diagnostic workflow can be specified for COPD patients, future research should define and validate an optimal cut-off value for BNP and NT-pro BNP with not only a high sensitivity, but also a high specificity.…”

“…12 However, these markers might also be elevated in COPD patients and are, therefore, not as specific as compared to non-COPD patients. [15][16][17] By using sensitive and specific diagnostic markers of AHF in COPD patients, appropriate and timely treatment could be given. Thereby, disease progression could be delayed, 10 and the length of hospital stay may be shortened.…”

Early Detection of Atrial Fibrillation in Chronic Obstructive Pulmonary Disease Patients

“…Interestingly, the NT-proBNP level is an independent predictor of COPD exacerbation, even in individuals without overt heart disease [ 67 ]. In addition, NT-proBNP levels were higher in COPD patients with an FEV1 of <50% compared with patients with higher FEV1 values [ 68 ]. In general, elevated NT-proBNP levels are a marker of a more severe course of COPD with worse clinical outcomes [ 68 ].…”

“…In addition, NT-proBNP levels were higher in COPD patients with an FEV1 of <50% compared with patients with higher FEV1 values [ 68 ]. In general, elevated NT-proBNP levels are a marker of a more severe course of COPD with worse clinical outcomes [ 68 ]. The development and progression of AF (from paroxysmal to persistent) are associated with gradual increases in serum levels of NT-proBNP and IL-6 and the MMP-9/TIMP-1 ratio [ 69 ].…”

Predictive Value of Smoking Index Combined with NT-proBNP for Patients with Pulmonary Hypertension Due to Chronic Lung Disease: A Retrospective Study

“…21,22 There are significant differences in the expression of NT-proBNP in different stages and progression of lung disease. 23 Researches indicate that raised NT-proBNP levels have been found in patients with chronic lung diseases and Pulmonary heart disease as a consequence of pulmonary hypertension, 24 suggesting that NT-proBNP is strongly associated with group 3 PH.…”