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Use of B-Type Natriuretic Peptide in the Risk Stratification of Acute Exacerbations of COPD^*

^* From the Department of Internal Medicine (Drs. Breidthardt, Christ-Crain, Bingisser, B. Mueller, and C. Mueller), and Clinic for Pneumology and Respiratory Cell Research (Drs. Stolz, Miedinger, Leuppi, and Tamm), University Hospital Basel, Switzerland.

Correspondence to: Christian Mueller, MD, Department of Internal Medicine, University Hospital, Petersgraben 4, CH-4031, Basel, Switzerland; e-mail: chmueller{at}uhbs.ch

Abstract

Background: In patients with 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 a 2-year follow-up was evaluated as the primary end point. The need for intensive care and in-hospital mortality were determined as secondary end points.

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

Key Words: chronic bronchitis • hospitalization • marker • outcome