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This Article Full Text (PDF) All Versions of this Article: chest.07-1959v1 133/5/1088    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Google Scholar Articles by Stolz, D. Articles by Mueller, C. PubMed PubMed Citation Articles by Stolz, D. Articles by Mueller, C.

Use of B-type Natriuretic Peptide in the Risk Stratification of Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Department of Internal Medicine, University Hospital Basel, Switzerland, Clinic for Pneumology and Respiratory Cell Research, University Hospital Basel, Switzerland

chmueller{at}uhbs.ch

Abstract

Background: In patients with chronic obstructive pulmonary disease (COPD) prognosis might be determined at least in part by the extent of cardiac stress induced by hypoxia and pulmonary arterial hypertension.

Methods: B-type natriuretic peptide (BNP), a quantitative marker of cardiac stress, was determined in 208 consecutive patients presenting to the emergency department with an acute exacerbation of COPD (AECOPD). The accuracy of BNP to predict death at 2-years follow up was evaluated as the primary endpoint. The need for intensive care and in-hospital mortality were determined as secondary endpoints.

Results: BNP levels were significantly elevated during the acute exacerbation compared to recovery (65pg/ml [34-189] vs. 45pg/ml [25-85], p<0.001), particularly in those patients requiring ICU treatment (105pg/ml [66-553] vs. 60pg/ml [31-169], p=0.007]. In multivariate Cox regression analysis BNP accurately predicted the need for ICU care (HR 1.13; 95%CI 1.03-1.24 for an increase in BNP of 100pg/ml; p=0.008). In a receiver operating characteristic (ROC) analysis to evaluate the potential of BNP levels to predict short- and long-term mortality the area under the curves was 0.55 (SD 0.71, 95%CI 0.41-0.68) and 0.56 (SD 0.53; 95%CI 0.45-0.66) respectively.

Conclusions: In patients with AECOPD, BNP levels independently predict the need for intensive care. However, BNP levels failed to adequately predict short-and long-term mortality in AECOPD patients.