Can NT-pro BNP Levels Predict Prognosis of Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease in the Intensive Care Unit?
Can NT-pro BNP Levels Predict Prognosis of Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease in the Intensive Care Unit?
Background: The prognostic value of amino terminal pro-brainnatriuretic peptide levels in patients with acute exacerbation ofchronic obstructive pulmonary disease has not been fully established.Aims: To investigate the predictive value of amino terminal pro-brainnatriuretic peptide levels in terms of mortality, need for noninvasivemechanical ventilation, invasive mechanical ventilation, and weaningsuccess.Study Design: Cohort study.Methods: Patients who were admitted to intensive care unit betweenDecember 2015 and December 2016 due to acute exacerbation ofchronic obstructive pulmonary disease were included in the study.Demographic data, noninvasive mechanical ventilation application,need for invasive mechanical ventilation, amino terminal pro-brainnatriuretic peptide level, duration of mechanical ventilation, intensivecare unit and hospital stay, weaning success, and mortality rates wererecorded.Results: A total of 110 patients (75 males) were included in the study.The mean age of the participants was 69 (61-76) years, and the meanAcute Physiology and Chronic Health Evaluation II score was 19 (15-23). The mean amino terminal pro-brain natriuretic peptide level wasfound to be lower in cases with noninvasive mechanical ventilationsuccess than those with noninvasive mechanical ventilation failure(p=0.053). In addition, the mean amino terminal pro-brain natriureticpeptide level was significantly higher (4740 pg/mL vs. 3004 pg/mL,p=0.001) in patients who needed invasive mechanical ventilationsupport than in patients who did not. The mortality rate wassignificantly higher in patients who had an increasing trend of aminoterminal pro-brain natriuretic peptide levels during hospitalizationthan in patients who had decreasing levels (59% vs. 23%, p=0.015).Based on the receiver operating characteristic analysis, the increasingtrend of amino terminal pro-brain natriuretic peptide levels duringintensive care unit stay predicted mortality with area under curveof 0.84 (p
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- 1. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global
Initiative for Chronic Obstructive Lung Diseases (GOLD) 2017.
- 2. Pan W, Yu J, Zhang L, Yang H, Yuan Y. Predictors of in-hospital mortality in patients
with acute exacerbation of COPD requiring ventilation: a retrospective study. Int J
Clin Exp Med 2016;9:22093-22101.
- 3. Marcun R, Sustic A, Brguljan PM, Kadivec S, Farkas J, Kosnik M, et al. Cardiac
biomarkers predict outcome after hospitalisation for an acute exacerbation of chronic
obstructive pulmonary disease. Int J Cardiol 2012;161:156-9.
- 4. Chang CL, Robinson SC, Mills GD, Sullivan GD, Karalus NC, McLachlan JD, et al.
Biochemical markers of cardiac dysfunction predict mortality in acute exacerbations
of COPD. Thorax 2011;66:764-8.
- 5. Pavasini R, Tavazzi G, Biscaglia S, Guerra F, Pecoraro A, Zaraket F, et al. Amino
terminal pro brain natriuretic peptide predicts all-cause mortality in patients with
chronic obstructive pulmonary disease: Systematic review and meta-analysis. Chron
Respir Dis 2017;14:117-26.
- 6. Bar SL, Swiggum E, Straatman L, Ignaszewski A. Nonheart failure-associated
elevation of amino terminal pro-brain natriuretic peptide in the setting of sepsis. Can
J Cardiol 2006;22:263-6.
- 7. Hawkins NM, Khosla A, Virani SA, McMurray JJ, FitzGerald JM. B-type natriuretic
peptides in chronic obstructive pulmonary disease: a systematic review. BMC Pulm
Med 2017;17:11.
- 8. Boles JM, Bion J, Connors A, Herridge M, Marsh M, Melot C, et al. Weaning from
mechanical ventilation. Eur Respir J 2007;29:1033-56.
- 9. Niewoehner DE, Lokhnygina Y, Rice K, Kuschner WG, Sharafkhaneh A, Sarosi
GA, et al. Risk indexes for exacerbations and hospitalizations due to COPD. Chest
2007;131:20-8.
- 10. Garcia-Aymerich J, Monso E, Marrades RM, Escarrabill J, Félez MA, Sunyer J,
et al. Risk factors for hospitalization for a chronic obstructive pulmonary disease
exacerbation. EFRAM study. Am J Respir Crit Care Med 2001;164:1002-7.
- 11. Inoue Y, Kawayama T, Iwanaga T, Aizawa H. High Plasma Brain Natriuretic Peptide
Levels in Stable COPD without Pulmonary Hypertension or Cor Pulmonale. Intern
Med 2009;48:503-12.
- 12. Budweiser S, Luchner A, Jörres RA, Heinemann F, Hitzl AP, Schmidbauer K, et al.
NT-pro BNP in chronic hypercapnic respiratory failure: a marker of disease severity,
treatment effect and prognosis. Respir Med 2007;101:2003-10.
- 13. Stolz D, Breidthardt T, Christ-Crain M, Bingisser R, Miedinger D, Leuppi J, et al. Use
of B-type natriuretic peptide in the risk stratification of acute exacerbations of COPD.
Chest 2008;133:1088-94.
- 14. Nishimura K, Nishimura T, Onishi K, Oga T, Hasegawa Y, Jones PW. Changes
in plasma levels of B-type natriuretic peptide with acute exacerbations of chronic
obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2014;9:155-62.
- 15. Sin DD, Man SF. Why are patients with chronic obstructive pulmonary disease at
increased risk of cardiovascular diseases? The potential role of systemic inflammation
in chronic obstructive pulmonary disease. Circulation 2003;107:1514-9.
- 16. Adrish M, Nannaka VB, Cano EJ, Bajantri B, Diaz-Fuentes G. Significance of NTpro
BNP in acute exacerbation of COPD patients without underlying left ventricular
dysfunction. Int J Chron Obstruct Pulmon Dis 2017;12:1183-9.
- 17. Vassaux C, Torre-Bouscoulet L, Zeineldine S, Cortopassi F, Paz-Díaz H, Celli BR, et
al. Effects of hyperinflation on the oxygen pulse as a marker of cardiac performance
in COPD. Eur Respir J 2008;32:1275-82.
- 18. Mallawany HE, Mahmoud MI, Morsi TS, El- Skiekh RM. Role of N-terminal pro
B-type natriuretic peptide in acute exacerbation of chronic obstructive pulmonary
disease. Egyptian Journal of Chest Diseases and Tuberculosis 2014;63:57-65.
- 19. Lari S, Attaran D, Vakilian F, Kamandi M, Disfani HF. Early Effectiveness of
Noninvasive Positive Pressure Ventilation on Right Ventricular Function in Chronic
Obstructive Pulmonary Disease Subjects with Acute Hyperapnic Respiratory Failure.
J Cardio Thorac Med 2017;5:558-63.
- 20. Shah KB, Nolan MM, Rao K, Wang DJ, Christenson RH, Shanholtz CB, et al.
The Characteristics and Prognostic Importance of NT-pro BNP Concentrations in
Critically ill Patients. Am J Med 2007;120:1071-7.
- 21. Brueckmann M, Huhle G, Lang S, Haase KK, Bertsch T, Weiss T, et al. Prognostic
Value of Plasma N-Terminal Pro-Brain Natriuretic Peptide in Patients With Severe
Sepsis. Circulation 2005;112:527-34.
- 22. Ruttem FH, Cramer MJ, Grobbee DE, Sachs AP, Kirkels JH, Lammers JW, et al.
Unrecognised heart failure in elderly patients with stable chronic obstructive
pulmonary disease. Eur Heart J 2005;26:1887-94.
- 23. Porhomayon J, Papadakos P, Nader ND. Failed Weaning from Mechanical Ventilation
and Cardiac Dysfunction. Crit Care Res Pract 2012;2012:173527.
- 24. Tsai SH, Lin YY, Chu SJ, Hsu CW, Cheng SM. Interpretation and Use of Natriuretic
Peptides in Non - Congestive Heart Failure Settings. Yonsei Med J 2010;51:151-63.
- 25. Hoiseth AD, Omland T, Hagve TA, Brekke PH, Soyseth V. NT-pro BNP independently
predicts long term mortality after acute exacerbation of COPD - a prospective cohort
study. Respir Res 2012;13:97.