Internal Medicine Service, Hospital Virgen de la Luz, Cuenca, Spain.
Eur J Intern Med. 2011 Apr;22(2):167-71. doi: 10.1016/j.ejim.2010.12.002. Epub 2011 Jan 5.
The prognostic value of NT-proBNP levels in patients admitted to hospital due to acute exacerbations of chronic pulmonary diseases (CPDs) is unknown.
Internal Medicine units at two general hospitals.
NT-proBNP levels were obtained within 72 h after admission in 192 consecutive patients with acute exacerbations of CPDs and no history of heart failure or diuretic treatment. Clinical characteristics and main outcomes were assessed over a 12-month follow-up. NT-proBNP cut-points for outcomes were obtained by ROC (receiver operating characteristics) curve analysis.
Chronic obstructive lung disease (69.3%) and chronic asthma (22.4%) were the most prevalent CPDs, and non-pneumonic acute respiratory infection (72.4%) and pneumonia (22.9%) were the most frequent causes of exacerbation. Atrial flutter or fibrillation rate was 11%. During the one-year follow-up period, 22 patients died, 42 were re-admitted, 46 received new long-term oxygen therapy, and 39 received new diuretic treatment. NT-proBNP values correlated with hospitalisation days. NT-proBNP values over 587.9 pg/ml were associated with significantly raised one-year mortality (OR=3.90; 95% IC 1.46-10.47; p=0.006) and over 782.2 pg/ml with cardio-pulmonary deaths (OR=6.38; 95% IC 1.91-21.3; p=0.002). That association persisted after adjustment for age, gender, creatinine levels and cardiac rhythm. NT-proBNP values over 628.7 pg/ml were associated with significantly higher probability of new diuretic treatment (OR=4.38; IC 95% 2.07-9.25; p<0.001). The negative predictive values for these cut-points ranged from 89% to 97%.
NT-proBNP levels below 587.9 pg/ml in patients with acute exacerbations of CPD were associated with favourable one-year outcomes.
在因慢性肺部疾病（CPD）急性加重而住院的患者中，NT-proBNP 水平的预后价值尚不清楚。
两家综合医院的内科病房。
对 192 例无心力衰竭或利尿剂治疗史的 CPD 急性加重患者入院后 72 小时内获得 NT-proBNP 水平。评估了 12 个月的随访期间的临床特征和主要结局。通过 ROC（接收者操作特性）曲线分析获得结局的 NT-proBNP 切点。
慢性阻塞性肺病（69.3%）和慢性哮喘（22.4%）是最常见的 CPD，非肺炎性急性呼吸道感染（72.4%）和肺炎（22.9%）是最常见的加重原因。房性颤动或心房扑动发生率为 11%。在一年的随访期间，22 名患者死亡，42 名患者再次入院，46 名患者接受了新的长期氧疗，39 名患者接受了新的利尿剂治疗。NT-proBNP 值与住院天数相关。NT-proBNP 值超过 587.9pg/ml 与一年死亡率显著升高相关（OR=3.90；95%CI 1.46-10.47；p=0.006），超过 782.2pg/ml 与心肺死亡相关（OR=6.38；95%CI 1.91-21.3；p=0.002）。调整年龄、性别、肌酐水平和心律后，这种关联仍然存在。NT-proBNP 值超过 628.7pg/ml 与新利尿剂治疗的可能性显著增加相关（OR=4.38；95%CI 2.07-9.25；p<0.001）。这些切点的阴性预测值在 89%至 97%之间。
CPD 急性加重患者的 NT-proBNP 水平低于 587.9pg/ml 与一年的良好结局相关。
