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Respiratory Research
Published in: Respiratory Research 1/2012

Open Access 01-12-2012 | Research

NT-proBNP independently predicts long term mortality after acute exacerbation of COPD – a prospective cohort study

Authors: Arne Didrik Høiseth, Torbjørn Omland, Tor-Arne Hagve, Pål H Brekke, Vidar Søyseth

Published in: Respiratory Research | Issue 1/2012

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Abstract

Background

Cardiovascular disease is prevalent and frequently unrecognized in patients with chronic obstructive pulmonary disease (COPD). NT-proBNP is an established risk factor in patients with heart failure. NT-proBNP may also be released from the right ventricle. Thus serum NT-proBNP may be elevated during acute exacerbations of COPD (AECOPD). The prognostic value of NT-proBNP in patients hospitalized with AECOPD is sparsely studied. Our objective was to test the hypothesis that NT-proBNP independently predicts long term mortality following AECOPD.

Methods

A prospective cohort study of 99 patients with 217 admissions with AECOPD. Clinical, electrocardiographic, radiological and biochemical data were collected at index and repeat admissions and analyzed in an extended survival analysis with time-dependent covariables.

Results

Median follow-up time was 1.9 years, and 57 patients died during follow-up. NT-proBNP tertile limits were 264.4 and 909 pg/mL, and NT-proBNP in tertiles 1 through 3 was associated with mortality rates of 8.6, 35 and 62 per 100 patient-years, respectively (age-adjusted log-rank p<0.0001). After adjustment for age, gender, peripheral edema, cephalization and cTnT in a multivariable survival model, the corresponding hazard ratios for dying were 2.4 (0.95-6.0) and 3.2 (1.3-8.1) (with 95% confidence intervals in parentheses, p-value for trend 0.013).

Conclusions

NT-proBNP is a strong and independent determinant of mortality after AECOPD.
Appendix
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Literature
1.
Patel AR, Hurst JR: Extrapulmonary comorbidities in chronic obstructive pulmonary disease: state of the art. Expert review of respiratory medicine. 2011, 5 (5): 647-662. 10.1586/ers.11.62.PubMedCrossRef
2.
Sidney S, Sorel M, Quesenberry CP, DeLuise C, Lanes S, Eisner MD: COPD and incident cardiovascular disease hospitalizations and mortality: Kaiser permanente medical care program. Chest. 2005, 128 (4): 2068-2075. 10.1378/chest.128.4.2068.PubMedCrossRef
3.
Huiart L, Ernst P, Suissa S: Cardiovascular morbidity and mortality in COPD. Chest. 2005, 128 (4): 2640-2646. 10.1378/chest.128.4.2640.PubMedCrossRef
4.
Curkendall SM, DeLuise C, Jones JK, Lanes S, Stang MR, Goehring E, She D: Cardiovascular disease in patients with chronic obstructive pulmonary disease, Saskatchewan Canada cardiovascular disease in COPD patients. Ann Epidemiol. 2006, 16 (1): 63-70. 10.1016/j.annepidem.2005.04.008.PubMedCrossRef
5.
Sin DD, Anthonisen NR, Soriano JB, Agusti AG: Mortality in COPD: role of comorbidities. Eur Respir J. 2006, 28 (6): 1245-1257. 10.1183/09031936.00133805.PubMedCrossRef
6.
Feary JR, Rodrigues LC, Smith CJ, Hubbard RB, Gibson JE: Prevalence of major comorbidities in subjects with COPD and incidence of myocardial infarction and stroke: a comprehensive analysis using data from primary care. Thorax. 2010, 65: 956-962. 10.1136/thx.2009.128082.PubMedCrossRef
7.
Brekke PH, Omland T, Smith P, Soyseth V: Underdiagnosis of myocardial infarction in C. Respir Med. 2008, 102 (9): 1243-1247. 10.1016/j.rmed.2008.04.010.PubMedCrossRef
8.
Buajordet I, Ebbesen J, Erikssen J, Brors O, Hilberg T: Fatal adverse drug events: the paradox of drug treatment. J Intern Med. 2001, 250 (4): 327-341. 10.1046/j.1365-2796.2001.00892.x.PubMedCrossRef
9.
McCullough PA, Hollander JE, Nowak RM, Storrow AB, Duc P, Omland T, McCord J, Herrmann HC, Steg PG, Westheim A, et al: Uncovering heart failure in patients with a history of pulmonary disease: rationale for the early use of B-type natriuretic peptide in the emergency department. Acad Emerg Med. 2003, 10 (3): 198-204. 10.1111/j.1553-2712.2003.tb01990.x.PubMedCrossRef
10.
Rutten FH, Moons KG, Cramer MJ, Grobbee DE, Zuithoff NP, Lammers JW, Hoes AW: Recognising heart failure in elderly patients with stable chronic obstructive pulmonary disease in primary care: cross sectional diagnostic study. BMJ. 2005, 331 (7529): 1379-10.1136/bmj.38664.661181.55.PubMedPubMedCentralCrossRef
11.
Brekke PH, Omland T, Holmedal SH, Smith P, Soyseth V: Determinants of cardiac troponin T elevation in COPD exacerbation - a cross-sectional study. BMC Pulm Med. 2009, 9: 35-10.1186/1471-2466-9-35.PubMedPubMedCentralCrossRef
12.
McAllister DA, Maclay JD, Mills NL, Leitch A, Reid P, Carruthers R, O'Connor J, McAlpine L, Chalmers G, Newby DE, et al: Diagnosis of myocardial infarction following hospitalisation for exacerbation of COPD. Eur RespirJ. 2012, 39 (5): 1097-1103. 10.1183/09031936.00124811.CrossRef
13.
Hoiseth AD, Omland T, Hagve TA, Brekke PH, Soyseth V: Determinants of high-sensitivity cardiac troponin T during acute exacerbation of chronic obstructive pulmonary disease: a prospective cohort study. BMC pulmonary medicine. 2012, 12 (1): 22-10.1186/1471-2466-12-22.PubMedPubMedCentralCrossRef
14.
Hoiseth AD, Neukamm A, Karlsson BD, Omland T, Brekke PH, Soyseth V: Elevated high-sensitivity cardiac troponin T is associated with increased mortality after acute exacerbation of chronic obstructive pulmonary disease. Thorax. 2011, 66 (9): 775-781. 10.1136/thx.2010.153122.PubMedCrossRef
15.
Chang CL, Robinson SC, Mills GD, Sullivan GD, Karalus NC, McLachlan JD, Hancox RJ: Biochemical markers of cardiac dysfunction predict mortality in acute exacerbations of COPD. Thorax. 2011
16.
Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, Stromberg A, van Veldhuisen DJ, Atar D, Hoes AW, et al: ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J. 2008, 29 (19): 2388-2442.PubMedCrossRef
17.
Medina AM, Marteles MS, Saiz EB, Martinez SS, Laiglesia FR, Rodriguez JA, Perez-Calvo JI: Prognostic utility of NT-proBNP in acute exacerbations of chronic pulmonary diseases. Eur J Intern Med. 2011, 22 (2): 167-171. 10.1016/j.ejim.2010.12.002.PubMedCrossRef
18.
Stolz D, Breidthardt T, Christ-Crain M, Bingisser R, Miedinger D, Leuppi J, Mueller B, Tamm M, Mueller C: Use of B-type natriuretic peptide in the risk stratification of acute exacerbations of COPD. Chest. 2008, 133 (5): 1088-1094. 10.1378/chest.07-1959.PubMedCrossRef
19.
Leuchte HH, Baumgartner RA, Nounou ME, Vogeser M, Neurohr C, Trautnitz M, Behr J: Brain natriuretic peptide is a prognostic parameter in chronic lung disease. Am J Respir Crit Care Med. 2006, 173 (7): 744-750. 10.1164/rccm.200510-1545OC.PubMedCrossRef
20.
van Gestel YR, Goei D, Hoeks SE, Sin DD, Flu WJ, Stam H, Mertens FW, Bax JJ, van Domburg RT, Poldermans D: Predictive value of NT-proBNP in vascular surgery patients with COPD and normal left ventricular systolic function. Copd. 2010, 7 (1): 70-75. 10.3109/15412550903499472.PubMedCrossRef
21.
Gale CP, White JE, Hunter A, Owen J, Allen J, Watson J, Holbrook I, Durham NP, Pye MP: Predicting mortality and hospital admission in patients with COPD: significance of NT pro-BNP, clinical and echocardiographic assessment. J Cardiovasc Med (Hagerstown). 2011, 12 (9): 613-618.
22.
Stamm JA, Belloli EA, Zhang Y, Bon J, Sciurba FC, Gladwin MT: Elevated N-terminal pro-brain natriuretic peptide is associated with mortality in tobacco smokers independent of airflow obstruction. PLoS One. 2011, 6 (11): e27416-10.1371/journal.pone.0027416.PubMedPubMedCentralCrossRef
23.
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 (7): 503-512. 10.2169/internalmedicine.48.1701.PubMedCrossRef
24.
Gemici G, Erdim R, Celiker A, Tokay S, Ones T, Inanir S, Oktay A: B-type natriuretic peptide levels in patients with COPD and normal right ventricular function. Adv Ther. 2008, 25 (7): 674-680. 10.1007/s12325-008-0067-1.PubMedCrossRef
25.
Martins CS, Rodrigues MJ, Miranda VP, Nunes JP: Prognostic value of cardiac troponin I in patients with COPD acute exacerbation. Neth J Med. 2009, 67 (10): 341-349.PubMed
26.
Rautaharju PM, Warren JW, Jain U, Wolf HK, Nielsen CL: Cardiac infarction injury score: an electrocardiographic coding scheme for ischemic heart disease. Circulation. 1981, 64 (2): 249-256. 10.1161/01.CIR.64.2.249.PubMedCrossRef
27.
Hurst JR, Vestbo J, Anzueto A, Locantore N, Mullerova H, Tal-Singer R, Miller B, Lomas DA, Agusti A, Macnee W, et al: Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med. 2010, 363 (12): 1128-1138. 10.1056/NEJMoa0909883.PubMedCrossRef
28.
Mantel N: Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer chemotherapy reports Part 1. 1966, 50 (3): 163-170.PubMed
29.
Kleinbaum DG, Klein M: Survival Analysis. A Self-Learning Text. 2005, New York: Springer
30.
Abroug F, Ouanes-Besbes L, Nciri N, Sellami N, Addad F, Hamda KB, Amor AB, Najjar MF, Knani J: Association of left-heart dysfunction with severe exacerbation of chronic obstructive pulmonary disease: diagnostic performance of cardiac biomarkers. Am J Respir Crit Care Med. 2006, 174 (9): 990-996. 10.1164/rccm.200603-380OC.PubMedCrossRef
31.
Omland T, Hagve TA: Natriuretic peptides: physiologic and analytic considerations. Heart Fail Clin. 2009, 5 (4): 471-487. 10.1016/j.hfc.2009.04.005.PubMedCrossRef
32.
33.
Arjamaa O, Nikinmaa M: Hypoxia regulates the natriuretic peptide system. Int J Physiol Pathophysiol Pharmacol. 2011, 3 (3): 191-201.PubMedPubMedCentral
34.
Renzetti AD, McClement JH, Litt BD: The Veterans Administration cooperative study of pulmonary function. 3. Mortality in relation to respiratory function in chronic obstructive pulmonary disease. Am J Med. 1966, 41 (1): 115-129. 10.1016/0002-9343(66)90009-X.PubMedCrossRef
35.
Mascarenhas J, Azevedo A, Bettencourt P: Coexisting chronic obstructive pulmonary disease and heart failure: implications for treatment, course and mortality. Curr Opin Pulm Med. 2010, 16 (2): 106-111. 10.1097/MCP.0b013e328335dc90.PubMedCrossRef
36.
Gariani K, Delabays A, Perneger TV, Agoritsas T: Use of brain natriuretic peptide to detect previously unknown left ventricular dysfunction in patients with acute exacerbation of chronic obstructive pulmonary disease. Swiss medical weekly. 2011, 141: w13298-PubMed
37.
Baggish AL, Siebert U, Lainchbury JG, Cameron R, Anwaruddin S, Chen A, Krauser DG, Tung R, Brown DF, Richards AM, et al: A validated clinical and biochemical score for the diagnosis of acute heart failure: the ProBNP Investigation of Dyspnea in the Emergency Department (PRIDE) Acute Heart Failure Score. Am Hear J. 2006, 151 (1): 48-54. 10.1016/j.ahj.2005.02.031.CrossRef
38.
Ouanes I, Jalloul F, Ayed S, Dachraoui F, Ouanes-Besbes L, Fekih Hassen M, Elatrous S, Abroug F: N-terminal proB-type natriuretic peptide levels aid the diagnosis of left ventricular dysfunction in patients with severe acute exacerbations of chronic obstructive pulmonary disease and renal dysfunction. Respirology. 2012, 17 (4): 660-666. 10.1111/j.1440-1843.2012.02153.x.PubMedCrossRef
39.
White HD: Pathobiology of troponin elevations: do elevations occur with myocardial ischemia as well as necrosis?. J Am Coll Cardiol. 2011, 57 (24): 2406-2408. 10.1016/j.jacc.2011.01.029.PubMedCrossRef
40.
Latini R, Masson S, Anand IS, Missov E, Carlson M, Vago T, Angelici L, Barlera S, Parrinello G, Maggioni AP, et al: Prognostic value of very low plasma concentrations of troponin T in patients with stable chronic heart failure. Circulation. 2007, 116 (11): 1242-1249. 10.1161/CIRCULATIONAHA.106.655076.PubMedCrossRef
41.
Omland T, de Lemos JA, Sabatine MS, Christophi CA, Rice MM, Jablonski KA, Tjora S, Domanski MJ, Gersh BJ, Rouleau JL, et al: A sensitive cardiac troponin T assay in stable coronary artery disease. N Engl J Med. 2009, 361 (26): 2538-2547. 10.1056/NEJMoa0805299.PubMedPubMedCentralCrossRef
42.
de Lemos JA, Drazner MH, Omland T, Ayers CR, Khera A, Rohatgi A, Hashim I, Berry JD, Das SR, Morrow DA, et al: Association of troponin T detected with a highly sensitive assay and cardiac structure and mortality risk in the general population. JAMA : the journal of the American Medical Association. 2010, 304 (22): 2503-2512. 10.1001/jama.2010.1768.PubMedCrossRef
43.
deFilippi CR, de Lemos JA, Christenson RH, Gottdiener JS, Kop WJ, Zhan M, Seliger SL: Association of serial measures of cardiac troponin T using a sensitive assay with incident heart failure and cardiovascular mortality in older adults. JAMA: the journal of the American Medical Association. 2010, 304 (22): 2494-2502. 10.1001/jama.2010.1708.PubMedCrossRef
44.
Seemungal TA, Hurst JR, Wedzicha JA: Exacerbation rate, health status and mortality in COPD–a review of potential interventions. Int J Chron Obstruct Pulmon Dis. 2009, 4: 203-223.PubMedPubMedCentralCrossRef
45.
Hosmer DW, Lemeshow S, May S: Applied survival analysis: regression modeling of time-to-event data. 2008, Hoboken, N.J.: Wiley-Interscience, 2CrossRef
46.
Brekke PH, Omland T, Holmedal SH, Smith P, Soyseth V: Troponin T elevation and long-term mortality after chronic obstructive pulmonary disease exacerbation. Eur Res pir J. 2008, 31 (3): 563-570. 10.1183/09031936.00015807.CrossRef
47.
Fruchter O, Yigla M: Cardiac Troponin-I predicts long-term mortality in chronic obstructive pulmonary disease. COPD: Journal of Chronic Obstructive Pulmonary Disease. 2009, 6 (3): 155-161. 10.1080/15412550902902620.PubMedCrossRef
Metadata
Title
NT-proBNP independently predicts long term mortality after acute exacerbation of COPD – a prospective cohort study
Authors
Arne Didrik Høiseth
Torbjørn Omland
Tor-Arne Hagve
Pål H Brekke
Vidar Søyseth
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Respiratory Research / Issue 1/2012
Electronic ISSN: 1465-993X
DOI
https://doi.org/10.1186/1465-9921-13-97

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