Diagnostic and prognostic value of N-terminal-proB-type natriuretic peptide (NT-proBNP) in patient with acute exacerbations of COPD

Abstract

Summary. Natriuretic peptide is an important marker of the heart failure. NT-proBNP has also been shown to play a role in predicting outcomes in unselected cohort of critically ill patients. This study was aimed at evaluation the diagnostic and prognostic value of NT-proBNP in patients with acute exacerbation of COPD (AECOPD). This was a prospective observational study enrolled 80 hospitalized patients with AECOPD (age, 65.8 ± 19.9 yrs; FEV1, 38.5 ± 17.3 %pred, PaO2, 53.8 ± 13.0 mmHg, PaCO2, 50.6 ± 15.1 mmHg). The patients underwent a comprehensive diagnostic algorithm including chest radiography, pulmonary function tests, echocardiography and serial measurements of plasma NT-proBNP (Biomedica). Main causes of acute exacerbation of COPD were purulent bronchitis (48.8 %), pneumonia (23.8 %), acute decompensation of chronic heart failure (ADCHF) (17.5 %), and pulmonary embolism (PE) (5 %). Mean plasma concentration of NT-proBNP in COPD patients was 1 057.8 ± 555.3 fmol / ml. NT-proBNP level was elevated in 88.7 % of the cases. Patients with AECOPD and PE had the highest level of NT-proBNP (1 735.9 ± 523.8 fmol / ml). NT-proBNP concentration in COPD patients with ADCHF was 1 405.4 ± 626.8 fmol / ml, in COPD patients with pneumonia – 1 043.5 ± 643.1 fmol / ml, and in COPD patients with purulent bronchitis – 906.6 ± 425.9 fmol / ml. In patients who died during hospital stay (8.4 %), plasma level of NT-proBNP was significantly higher than in survivors (1 484.6 ± 618.7 vs 1 003.7 ± 527.1, respectively, p = 0.013). Conclusions: Plasma level of NT-proBNP may be used as a marker of severity and prognosis in AECOPD.