The role of plasma N-terminal brain natriuretic pro-peptide in diagnosing elderly patients with acute exacerbation of COPD concurrent with left heart failure

Abstract

IntroductionAcute exacerbation of COPD (AECOPD) and left heart failure (LHF) commonly exist together in clinical practice. However, the identification of AECOPD concurrent with LHF is currently challenging. Our study aimed to investigate the role of plasma N-terminal brain natriuretic pro-peptide (NT-proBNP) in diagnosing elderly patients with AECOPD associated with LHF.Methods and resultsLHF was diagnosed in patients with AECOPD according to echocardiographic criteria, and the levels of NT-proBNP in plasma were measured by quantitative electrochemiluminescence assay. Among the 655 patients with AECOPD, 158 (24.1%) had comorbid LHF, whether systolic (n=108, 68.4%) or diastolic (n=50, 31.6%). The plasma concentrations of NT-proBNP in elderly patients with AECOPD associated with LHF were markedly elevated, compared with those with only AECOPD (4,542.5 and 763.0 ng/L, respectively, P<0.01). The receiver operating characteristic curve indicated a diagnostic cutoff value of 1,677.5 ng/L of NT-proBNP in plasma for ascertaining the presence of LHF in AECOPD, with a sensitivity of 87.9%, a specificity of 88.5%, and an accuracy of 88.4%.ConclusionThe plasma level of NT-proBNP may be a useful indicator in diagnosing AECOPD associated with LHF.

2021 Guideline for the Management of COPD Exacerbations: Emergency Medicine Association of Turkey (EMAT) / Turkish Thoracic Society (TTS) Clinical Practice Guideline Task Force

“…[ 23 24 ] Moreover, the plasma concentrations of NT-proBNP are markedly increased in patients with COPD exacerbation and left ventricular failure compared with those in patients with COPD exacerbation alone. [ 25 ] We suggest that BNP/NT-proBNP tests should be used for performing differential diagnosis in patients with undifferentiated diagnosis presenting with dyspnea and in patients with both COPD and CHF to help distinguish whether the patient primarily has an exacerbation of CHF or that of COPD.…”

Comorbidities and natriuretic peptide plasma levels

“…Therefore, relationship between NT-proBNP plasma levels, comorbidity and diagnostic cutoff is still a matter of debate. Guo et al [5] evaluated the role of plasma NT-proBNP in diagnosing elderly patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and HF. They concluded that NT-proBNP diagnostic cutoff of 1,677 ng/L is suggestive of presence of HF associated with COPD.…”