Izhakian Shimon, Frajman Assaf, Hayat Ariel D, Gorenshtein Alon, Shtraichman Osnat, Freidkin Lev, Rosengarten Dror, Kramer Mordechai R
Rabin Medical Center-Beilinson Hospital, Pulmonary Institute Petach Tikva Israel.
Faculty of Medicine Tel Aviv University Tel Aviv Israel.
Pulm Circ. 2024 Aug 15;14(3):e12427. doi: 10.1002/pul2.12427. eCollection 2024 Jul.
The prognostic significance of pretransplant N-terminal pro-brain (B)-type natriuretic peptide (NT-proBNP) level has not been investigated in lung transplant recipients. The electronic files of 173 patients with chronic lung disease who underwent lung transplantation in 2018-2022 at a tertiary medical center were retrospectively reviewed. Right heart catheterization (RHC) and NT-proBNP determination were performed preoperatively in all cases. Pretransplant demographic, clinical, and laboratory data were compared between posttransplant survivors and nonsurvivors. Correlations of NT-proBNP values with lung function and RHC parameters and all-cause mortality were analyzed. NT-proBNP level correlated positively with mean pulmonary artery pressure ( = 0.51, < 0.001) and pulmonary vascular resistance (PVR) ( = 0.45, = 0.0013), and negatively with diffusing lung capacity for carbon monoxide ( = -0.25, = 0.0017), cardiac index ( = -0.26, = 0.001), and cardiac output ( = -0.23, = 0.004). Over a median follow-up time of 23.22 months, 74 patients died. On univariate analysis, mortality was significantly associated with higher log-NT-proBNP (hazard ratio [HR] = 0.54, 95% confidence interval [CI] 1.15-2.05, = 0.016), older age at transplant registration (HR = 1.033, 95% CI 1.009-1.058, = 0.0068), higher PVR (HR 1.15, 95% CI 1.07-1.23, = 0.015), and lower cardiac output (HR = 0.62, 95% CI 0.42-0.92, = 0.045). On multivariate analysis adjusted for age, sex, and body mass index, mortality significance was maintained only for higher log-NT-proBNP (HR = 1.54, 95% CI 1.12-2.11, = 0.007). Among lung transplant recipients, pretransplant NT-proBNP levels correlated well with RHC parameters and were strongly associated with posttransplantation mortality. Assessment of NT-proBNP may improve risk stratification of lung transplant candidates.
肺移植受者移植前N末端脑钠肽前体（NT-proBNP）水平的预后意义尚未得到研究。回顾性分析了2018年至2022年在一家三级医疗中心接受肺移植的173例慢性肺病患者的电子病历。所有病例术前均进行了右心导管检查（RHC）和NT-proBNP测定。比较了移植后存活者和非存活者的移植前人口统计学、临床和实验室数据。分析了NT-proBNP值与肺功能、RHC参数和全因死亡率的相关性。NT-proBNP水平与平均肺动脉压（r = 0.51，P < 0.001）和肺血管阻力（PVR）（r = 0.45，P = 0.0013）呈正相关，与一氧化碳弥散量（r = -0.25，P = 0.0017）、心脏指数（r = -0.26，P = 0.001）和心输出量（r = -0.23，P = 0.004）呈负相关。在中位随访时间23.22个月内，74例患者死亡。单因素分析显示，死亡率与较高的log-NT-proBNP显著相关（风险比[HR] = 0.54，95%置信区间[CI] 1.15 - 2.05，P = 0.016）、移植登记时年龄较大（HR = 1.033，95% CI 1.009 - 1.058，P = 0.0068）、较高的PVR（HR 1.15，95% CI 1.07 - 1.23，P = 0.015）和较低的心输出量（HR = 0.62，95% CI 0.42 - 0.92，P = 0.045）有关。多因素分析在调整年龄、性别和体重指数后，仅较高的log-NT-proBNP仍具有死亡率显著意义（HR = 1.54，95% CI 1.12 - 2.11，P = 0.007）。在肺移植受者中，移植前NT-proBNP水平与RHC参数相关性良好，且与移植后死亡率密切相关。评估NT-proBNP可能改善肺移植候选者的风险分层。
