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Prognostic Role of NT-proBNP for in-Hospital and 1-Year Mortality in Patients with Acute Exacerbations of COPD

Authors Li H, Zeng Z, Cheng J, Hu G, Li Y, Wei L, Zhou Y, Ran P

Received 20 September 2019

Accepted for publication 10 December 2019

Published 8 January 2020 Volume 2020:15 Pages 57—67


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Prof. Dr. Chunxue Bai

Haiqing Li, 1 Zixiong Zeng, 1 Juan Cheng, 1 Guoping Hu, 1 Yuqun Li, 1 Liping Wei, 1 Yumin Zhou, 2 Pixin Ran 2

1Department of Respiratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China; 2Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China

Correspondence: Guoping Hu
Department of Respiratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
Tel +86 20-81292146
Pixin Ran
Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, Guangdong 510120, People’s Republic of China
Tel/Fax +86 20-81340482

Background and objective: The association between N-terminal pro B-type natriuretic peptide (NT-proBNP) concentrations and in-hospital and 1-year mortality in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients is largely unknown. Our objective was to explore the usefulness of NT-proBNP concentrations in AECOPD patients as a prognostic marker for in-hospital and 1-year mortality.
Methods: NT-proBNP levels were measured in patients upon admission and laboratory and clinical data were also recorded. The cut-point for the NT-proBNP concentration level for in-hospital death was obtained using the receiver operating characteristic (ROC) curve. Univariate and multivariate logistic regression and Cox regression were used in the analyses of factors of in-hospital and 1-year mortality.
Results: A total of 429 patients were enrolled. Twenty-nine patients died during hospitalization and 59 patients died during the 1-year follow-up. Patients who died in-hospital compared with those in-hospital survivors were older (80.14± 6.56 vs 75.93± 9.45 years, p=0.003), had a higher percentage of congestive heart failure (65.52% vs 33.75%, p< 0.001), had higher NT-proBNP levels (5767.00 (1372.50– 12,887.00) vs 236.25 (80.03– 1074.75) ng/L, p< 0.001), higher neutrophil counts (10.52± 5.82 vs 7.70± 4.31, p=0.016), higher D-dimer levels (1231.62± 1921.29 vs 490.11± 830.19, p=0.048), higher blood urea nitrogen levels (9.91± 6.33 vs 6.51± 4.01 mmol/L, p=0.001), a lower body mass index (19.49± 3.57 vs 22.19± 4.76, p=0.003), and higher hemoglobin levels (122.34± 25.36 vs 130.57± 19.63, p=0.034). The area under the ROC curve (AUC) for NT-proBNP concentration was 0.88 (95% confidence interval [CI], 0.84– 0.93). NT-proBNP concentrations ≥ 551.35 ng/L were an independent prognostic factor for both in-hospital and 1-year mortality after adjustment for relative risk (RR) (RR=29.54, 95% CI 3.04– 286.63, p=0.004 for the multivariate logistic regression analysis) and hazard ratio (HR) (HR=4.47, 95% CI, 2.38– 8.41, p < 0.001 for the multivariate cox regression analysis).
Conclusion: NT-proBNP was a strong and independent predictor of in-hospital and 1-year mortality in AECOPD patients.

Keywords: AECOPD, NT-proBNP, mortality, prognosis

Corrigendum for this paper has been published

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