TY - JOUR
T1 - NT-proBNP in stable COPD and future exacerbation risk
T2 - Analysis of the SPIROMICS cohort
AU - Labaki, Wassim W.
AU - Xia, Meng
AU - Murray, Susan
AU - Curtis, Jeffrey L.
AU - Barr, R. Graham
AU - Bhatt, Surya P.
AU - Bleecker, Eugene R.
AU - Hansel, Nadia N.
AU - Cooper, Christopher B.
AU - Dransfield, Mark T.
AU - Wells, J. Michael
AU - Hoffman, Eric A.
AU - Kanner, Richard E.
AU - Paine, Robert
AU - Ortega, Victor E.
AU - Peters, Stephen P.
AU - Krishnan, Jerry A.
AU - Bowler, Russell P.
AU - Couper, David J.
AU - Woodruff, Prescott G.
AU - Martinez, Fernando J.
AU - Martinez, Carlos H.
AU - Han, Mei Lan K.
N1 - Publisher Copyright:
© 2018 Elsevier Ltd
PY - 2018/7
Y1 - 2018/7
N2 - Background: High N-terminal pro-brain natriuretic peptide (NT-proBNP) during COPD exacerbations is associated with worse clinical outcomes. The prognostic value of NT-proBNP measured during clinical stability has not been well characterized. Methods: We studied SPIROMICS participants 40–80 years of age with COPD GOLD spirometric stages 1–4. The association between baseline NT-proBNP and incident COPD exacerbations within one year of follow-up was tested using zero-inflated Poisson regression models adjusted for age, gender, race, body mass index, current smoking status, smoking history, FEV1 percent predicted, COPD Assessment Test score, exacerbation history, total lung capacity on chest CT and cardiovascular disease (any of coronary artery disease, myocardial infarction or congestive heart failure). Results: Among 1051 participants (mean age 66.1 years, 41.4% women), mean NT-proBNP was 608.9 pg/ml. Subjects in GOLD stage D had the highest mean NT-proBNP. After one year of follow-up, 268 participants experienced one or more COPD exacerbations. One standard deviation increase in baseline NT-proBNP was associated with a 13% increase in the risk of incident exacerbations (incident risk ratio 1.13; 95% CI 1.06–1.19; p < 0.0001). This association was maintained in participants with and without cardiovascular disease. Conclusion: Baseline NT-proBNP in COPD is an independent predictor of respiratory exacerbations, even in individuals without overt cardiac disease. The impact of detection and treatment of early cardiovascular dysfunction on COPD exacerbation frequency warrants further investigation.
AB - Background: High N-terminal pro-brain natriuretic peptide (NT-proBNP) during COPD exacerbations is associated with worse clinical outcomes. The prognostic value of NT-proBNP measured during clinical stability has not been well characterized. Methods: We studied SPIROMICS participants 40–80 years of age with COPD GOLD spirometric stages 1–4. The association between baseline NT-proBNP and incident COPD exacerbations within one year of follow-up was tested using zero-inflated Poisson regression models adjusted for age, gender, race, body mass index, current smoking status, smoking history, FEV1 percent predicted, COPD Assessment Test score, exacerbation history, total lung capacity on chest CT and cardiovascular disease (any of coronary artery disease, myocardial infarction or congestive heart failure). Results: Among 1051 participants (mean age 66.1 years, 41.4% women), mean NT-proBNP was 608.9 pg/ml. Subjects in GOLD stage D had the highest mean NT-proBNP. After one year of follow-up, 268 participants experienced one or more COPD exacerbations. One standard deviation increase in baseline NT-proBNP was associated with a 13% increase in the risk of incident exacerbations (incident risk ratio 1.13; 95% CI 1.06–1.19; p < 0.0001). This association was maintained in participants with and without cardiovascular disease. Conclusion: Baseline NT-proBNP in COPD is an independent predictor of respiratory exacerbations, even in individuals without overt cardiac disease. The impact of detection and treatment of early cardiovascular dysfunction on COPD exacerbation frequency warrants further investigation.
KW - Brain natriuretic peptides
KW - Cardiovascular disease
KW - Chronic obstructive pulmonary disease
KW - Respiratory exacerbation
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U2 - 10.1016/j.rmed.2018.06.005
DO - 10.1016/j.rmed.2018.06.005
M3 - Article
C2 - 29957287
AN - SCOPUS:85048542620
SN - 0954-6111
VL - 140
SP - 87
EP - 93
JO - Respiratory Medicine
JF - Respiratory Medicine
ER -