NT-proBNP 对 COPD 急性加重患者住院期间和 1 年死亡率的预后作用。

Prognostic Role of NT-proBNP for in-Hospital and 1-Year Mortality in Patients with Acute Exacerbations of COPD.

机构信息

Department of Respiratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China.

Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China.

出版信息

Int J Chron Obstruct Pulmon Dis. 2020 Jan 8;15:57-67. doi: 10.2147/COPD.S231808. eCollection 2020.

DOI:10.2147/COPD.S231808

PMID:32021144

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6955621/

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 in-hospital 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 in-hospital 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.

摘要

背景和目的

N 端脑利钠肽前体（NT-proBNP）浓度与慢性阻塞性肺疾病急性加重（AECOPD）患者住院期间和 1 年死亡率之间的关系在很大程度上尚不清楚。我们的目的是探讨 NT-proBNP 浓度在 AECOPD 患者中的有用性，作为住院期间和 1 年死亡率的预后标志物。

方法

入院时测量 NT-proBNP 水平，并记录实验室和临床数据。使用受试者工作特征（ROC）曲线获得 NT-proBNP 浓度水平的住院死亡截断值。使用单变量和多变量逻辑回归和 Cox 回归分析住院和 1 年死亡率的因素。

结果

共纳入 429 例患者。29 例患者在住院期间死亡，59 例患者在 1 年随访期间死亡。与住院幸存者相比，住院期间死亡的患者年龄更大（80.14±6.56 岁 vs 75.93±9.45 岁，p=0.003），充血性心力衰竭的比例更高（65.52% vs 33.75%，p<0.001），NT-proBNP 水平更高（5767.00（1372.50-12887.00）ng/L vs 236.25（80.03-1074.75）ng/L，p<0.001），中性粒细胞计数更高（10.52±5.82 vs 7.70±4.31，p=0.016），D-二聚体水平更高（1231.62±1921.29 vs 490.11±830.19，p=0.048），血尿素氮水平更高（9.91±6.33 vs 6.51±4.01 mmol/L，p=0.001），体重指数更低（19.49±3.57 vs 22.19±4.76，p=0.003），血红蛋白水平更高（122.34±25.36 vs 130.57±19.63，p=0.034）。NT-proBNP 浓度的 ROC 曲线下面积（AUC）为 0.88（95%置信区间 [CI]，0.84-0.93）。在调整相对风险（RR）（RR=29.54，95%CI 3.04-286.63，p=0.004 用于多变量逻辑回归分析）和危险比（HR）（HR=4.47，95%CI，2.38-8.41，p <0.001 用于多变量 Cox 回归分析）后，NT-proBNP 浓度≥551.35 ng/L 是住院和 1 年死亡率的独立预后因素。