Significance of NT-pro-BNP in acute exacerbation of COPD patients without underlying left ventricular dysfunction

Int J Chron Obstruct Pulmon Dis. 2017 Apr 13:12:1183-1189. doi: 10.2147/COPD.S134953. eCollection 2017.

Abstract

Background: 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.

Methods: 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.

Results: 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 (P=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 (r=0.3658; 95% confidence interval [CI]: 0.2060-0.5067; P<0.0001). Patients with elevated NT-pro-BNP levels were more likely to require intensive care (63% vs 43%; P=0.0207) and had a longer hospital length of stay (P=0.0052). There were no differences in the need for noninvasive positive pressure ventilation (P=0.1245) or mechanical ventilation (P=0.9824) or in regard to in-hospital mortality (P=0.5273).

Conclusion: 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.

Keywords: COPD; NT-pro-BNP; acute exacerbation of COPD; natriuretic peptide.

MeSH terms

  • Aged
  • Biomarkers / blood
  • Disease Progression
  • Female
  • Humans
  • Intensive Care Units
  • Length of Stay
  • Lung / physiopathology*
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood*
  • Noninvasive Ventilation
  • Patient Admission
  • Peptide Fragments / blood*
  • Positive-Pressure Respiration
  • Predictive Value of Tests
  • Prognosis
  • Pulmonary Disease, Chronic Obstructive / blood*
  • Pulmonary Disease, Chronic Obstructive / diagnosis
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Pulmonary Disease, Chronic Obstructive / therapy
  • Retrospective Studies
  • Risk Factors
  • Tracheostomy
  • Up-Regulation

Substances

  • Biomarkers
  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain