Adrish Muhammad, Nannaka Varalaxmi Bhavani, Cano Edison J, Bajantri Bharat, Diaz-Fuentes Gilda
Division of Pulmonary and Critical Care Medicine, Bronx-Lebanon Hospital Center, Icahn School of Medicine at Mount Sinai.
Department of Critical Care Medicine, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine.
Int J Chron Obstruct Pulmon Dis. 2017 Apr 13;12:1183-1189. doi: 10.2147/COPD.S134953. eCollection 2017.
B-type natriuretic peptide (BNP) and the N-terminal fragment of pro-BNP (NT-pro-BNP) are established biomarkers of heart failure. Increased levels of natriuretic peptide (NP) have been associated with poor outcomes in acute exacerbation of COPD (AECOPD); however, most studies did not address the conditions that can also increase NT-pro-BNP levels. We aimed to determine if NT-pro-BNP levels correlate with outcomes of AECOPD in patients without heart failure and other conditions that can affect NT-pro-BNP levels.
We conducted a retrospective study in patients hospitalized for AECOPD with available NT-pro-BNP levels and normal left ventricular ejection fraction. We compared patients with normal and elevated NT-pro-BNP levels and analyzed the clinical and outcome data.
A total of 167 of 1,420 (11.7%) patients met the study criteria. A total of 77% of male patients and 53% of female patients had elevated NT-pro-BNP levels (=0.0031). NT-pro-BNP levels were not associated with COPD severity and comorbid illnesses. Log-transformed NT-pro-BNP levels were positively associated with echocardiographically estimated right ventricular systolic pressure (=0.3658; 95% confidence interval [CI]: 0.2060-0.5067; <0.0001). Patients with elevated NT-pro-BNP levels were more likely to require intensive care (63% vs 43%; =0.0207) and had a longer hospital length of stay (=0.0052). There were no differences in the need for noninvasive positive pressure ventilation (=0.1245) or mechanical ventilation (=0.9824) or in regard to in-hospital mortality (=0.5273).
Patients with AECOPD and elevated NT-pro-BNP levels had increased hospital length of stay and need for intensive care. Based on our study, serum NT-pro-BNP levels cannot be used as a biomarker for increased mortality or requirement for invasive or noninvasive ventilation in this group of patients.
B型利钠肽（BNP）和氨基末端脑钠肽前体（NT-pro-BNP）是公认的心力衰竭生物标志物。利钠肽（NP）水平升高与慢性阻塞性肺疾病急性加重期（AECOPD）的不良预后相关；然而，大多数研究并未探讨那些也可能导致NT-pro-BNP水平升高的情况。我们旨在确定在没有心力衰竭及其他可影响NT-pro-BNP水平的疾病的患者中，NT-pro-BNP水平是否与AECOPD的预后相关。
我们对因AECOPD住院且NT-pro-BNP水平可用、左心室射血分数正常的患者进行了一项回顾性研究。我们比较了NT-pro-BNP水平正常和升高的患者，并分析了临床和预后数据。
1420例患者中有167例（11.7%）符合研究标准。男性患者中77%、女性患者中53%的NT-pro-BNP水平升高（P=0.0031）。NT-pro-BNP水平与COPD严重程度及合并症无关。经对数转换的NT-pro-BNP水平与超声心动图估算的右心室收缩压呈正相关（P=0.3658；95%置信区间[CI]：0.2060-0.5067；P<0.0001）。NT-pro-BNP水平升高的患者更有可能需要重症监护（63%对43%；P=0.0207），且住院时间更长（P=0.0052）。在无创正压通气需求（P=0.1245）、机械通气需求（P=0.9824）或院内死亡率方面（P=0.5273）无差异。
AECOPD且NT-pro-BNP水平升高的患者住院时间延长且需要重症监护。根据我们的研究，血清NT-pro-BNP水平不能作为该组患者死亡率增加或有创或无创通气需求的生物标志物。
