NT-proBNP in stable COPD and future exacerbation risk: Analysis of the SPIROMICS cohort.

TitleNT-proBNP in stable COPD and future exacerbation risk: Analysis of the SPIROMICS cohort.
Publication TypePublication
Year2018
AuthorsLabaki WW, Xia M, Murray S, Curtis JL, R Barr G, Bhatt SP, Bleecker ER, Hansel NN, Cooper CB, Dransfield MT, J Wells M, Hoffman EA, Kanner RE, Paine R, Ortega VE, Peters SP, Krishnan JA, Bowler RP, Couper DJ, Woodruff PG, Martinez FJ, Martinez CH, Han MK
JournalRespir Med
Volume140
Pagination87-93
Date Published2018 07
ISSN1532-3064
KeywordsAcute Disease, Adult, Aged, Aged, 80 and over, biomarkers, Female, Follow-Up Studies, Forced Expiratory Volume, Humans, Male, Middle Aged, Natriuretic Peptide, Brain, Peptide Fragments, Prognosis, Pulmonary Disease, Chronic Obstructive, Risk Assessment, Spirometry, Vital Capacity
Abstract

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, FEV 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.

DOI10.1016/j.rmed.2018.06.005
Alternate JournalRespir Med
PubMed ID29957287
PubMed Central IDPMC6084793
Grant ListR01 HL130883 / HL / NHLBI NIH HHS / United States
U24 HL141762 / HL / NHLBI NIH HHS / United States
K08 HL118128 / HL / NHLBI NIH HHS / United States
P30 ES005605 / ES / NIEHS NIH HHS / United States
P30 ES006694 / ES / NIEHS NIH HHS / United States
K24 HL137013 / HL / NHLBI NIH HHS / United States
R01 HL126838 / HL / NHLBI NIH HHS / United States
HHSN268200900015C / HL / NHLBI NIH HHS / United States
I01 CX000911 / CX / CSRD VA / United States
U01 HL137880 / HL / NHLBI NIH HHS / United States
R01 HL122438 / HL / NHLBI NIH HHS / United States
HHSN268200900013C / HL / NHLBI NIH HHS / United States
HHSN268200900014C / HL / NHLBI NIH HHS / United States
K24 HL138188 / HL / NHLBI NIH HHS / United States
T32 HL007749 / HL / NHLBI NIH HHS / United States
HHSN268200900019C / HL / NHLBI NIH HHS / United States
K23 HL133438 / HL / NHLBI NIH HHS / United States
K24 HL140108 / HL / NHLBI NIH HHS / United States
HHSN268200900016C / HL / NHLBI NIH HHS / United States
K08 HL123940 / HL / NHLBI NIH HHS / United States
HHSN268200900018C / HL / NHLBI NIH HHS / United States
P30 DK054759 / DK / NIDDK NIH HHS / United States
HHSN268200900017C / HL / NHLBI NIH HHS / United States
HHSN268200900020C / HL / NHLBI NIH HHS / United States
MS#: 
MS095
Manuscript Full Title: 
NT-proBNP in stable COPD and future exacerbation risk: Analysis of the SPIROMICS cohort.
Manuscript Lead/Corresponding Author Affiliation: 
Clinical Center: Michigan (University of Michigan)
ECI: 
Manuscript Status: 
Published and Public