Shafuddin Eskandarain, Fairweather Sarah M, Chang Catherina L, Tuffery Christine, Hancox Robert J
Dept of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand.
These authors contributed equally.
ERJ Open Res. 2021 Feb 22;7(1). doi: 10.1183/23120541.00531-2020. eCollection 2021 Jan.
COPD patients often have cardiac comorbidities. Cardiac involvement at the time of a COPD exacerbation is associated with a high short-term mortality, but whether this influences long-term outcomes is unknown. We explored whether biomarkers of cardiac dysfunction at the time of a COPD exacerbation predict long-term outcomes.
Two prospective cohorts of patients admitted to Waikato Hospital for exacerbations of COPD were recruited during 2006-2007 and 2012-2013. N-terminal pro-B-type natriuretic peptide (NT-proBNP) and troponin T were measured on admission and were used to indicate cardiac stretch and myocardial injury, respectively. 5-year survival after discharge and subsequent admissions for cardiac disease and COPD exacerbations were analysed using Kaplan-Meier and Cox proportional hazards tests.
The overall 5-year mortality was 61%. Patients with high NT-proBNP on admission had higher mortality than those with normal cardiac biomarkers (adjusted hazard ratio (aHR) 1.76, 95% CI 1.18-2.62). High NT-proBNP was also associated with a higher risk of future cardiac admissions (aHR 1.75, 95% CI 1.2-2.55). Troponin T levels were not associated with long-term survival (aHR 0.86, 95% CI 0.40-1.83) or future cardiac admissions (aHR 0.74, 95% CI 0.34-1.57). Neither biomarker predicted future COPD exacerbations.
The long-term prognosis following a hospitalisation for an exacerbation of COPD is poor with less than half of patients surviving for 5 years. Elevated NT-proBNP at the time of a COPD exacerbation is associated with higher long-term mortality and a greater likelihood of future cardiac admissions, but not future COPD exacerbations.
慢性阻塞性肺疾病（COPD）患者常伴有心脏合并症。COPD急性加重期出现心脏受累与短期高死亡率相关，但这是否会影响长期预后尚不清楚。我们探讨了COPD急性加重期心脏功能障碍的生物标志物是否能预测长期预后。
在2006 - 2007年和2012 - 2013年期间，招募了两组因COPD急性加重入住怀卡托医院的前瞻性队列患者。入院时检测N末端B型利钠肽原（NT-proBNP）和肌钙蛋白T，分别用于指示心脏牵张和心肌损伤。使用Kaplan-Meier法和Cox比例风险检验分析出院后5年生存率以及随后因心脏病和COPD急性加重再次入院的情况。
总体5年死亡率为61%。入院时NT-proBNP水平高的患者死亡率高于心脏生物标志物正常的患者（校正风险比[aHR] 1.76，95%置信区间[CI] 1.18 - 2.62）。高NT-proBNP还与未来心脏再次入院风险较高相关（aHR 1.75，95% CI 1.2 - 2.55）。肌钙蛋白T水平与长期生存率（aHR 0.86，95% CI 0.40 - 1.83）或未来心脏再次入院（aHR 0.74，95% CI 0.34 - 1.57）无关。两种生物标志物均不能预测未来的COPD急性加重。
因COPD急性加重住院后的长期预后较差，不到一半的患者能存活5年。COPD急性加重期NT-proBNP升高与较高的长期死亡率和未来心脏再次入院的可能性增加相关，但与未来的COPD急性加重无关。
