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What Is the Value of Midregional Proatrial Natriuretic Peptide in COPD Research or Clinical Practice?Midregional Proatrial Natriuretic Peptide in COPD FREE TO VIEW

Saadah Alrajab, MD, MPH; Askin Uysal, MD
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From the Department of Pulmonary and Critical Care, Louisiana State University-Shreveport.

Correspondence to: Saadah Alrajab, MD, MPH, Department of Pulmonary and Critical Care, Louisiana State University-Shreveport, 1501 Kings Hwy, Shreveport, LA 71103; e-mail: salraj@lsuhsc.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(2):555. doi:10.1378/chest.10-3129
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To the Editor:

We read with great interest the study by Bernasconi and colleagues1 published recently in CHEST (July 2011). According to the study, high midregional proatrial natriuretic peptide (MR-proANP) level was associated, as was high Paco2, with a worse 2-year survival rate compared with normal or lower values.

Pulmonary hypertension was not well documented in this study and depended only on historic echocardiographic reports. Pulmonary hypertension was not associated with mortality, contrary to other studies. Cardiopathy (not well explained) was present in 45% of study participants, and those had potentially higher MR-proANP levels due to their cardiac disease, not to COPD-related right-sided heart strain. High numbers of deaths from nonpulmonary-related causes also were noted in this study (12 of 37 died of cardiac causes, five of 37 of other causes, and 10 of 37 of concomitant malignancies).

The authors admit a possible bias by recruiting patients from a single center, including only those requiring admission to the hospital and excluding exacerbations treated as outpatient. This bias may have reduced the ability of the study to evaluate MR-proANP on COPD exacerbations in general.

The study revealed prognostic values of Paco2 (with very good hazard ratios and CIs) and MR-proANP (hazard ratio, 1.68; close-to-null 95% CI, 1.03-2.7). In clinical practice, and even future research, it is much more cost-effective to depend on Paco2, which is a handy and readily available test for most patients with COPD requiring hospital admission, than on an expensive and potentially confusing test that overlaps with other very common conditions such as renal failure and heart disease.

MR-proANP did not offer any prediction for reexacerbations and would not change our clinical practice if applied. Furthermore, it might be just one factor among many others, such as advanced disease stage indicated by a low FEV1 mean of 0.89 L,1 advanced age, and a high Charlson comorbidity score.2

Bernasconi M, Tamm M, Bingisser R, et al. Midregional proatrial natriuretic peptide predicts survival in exacerbations of COPD. Chest. 2011;1401:91-99. [CrossRef] [PubMed]
 
Hall WH, Ramachandran R, Narayan S, Jani AB, Vijayakumar S. An electronic application for rapidly calculating Charlson comorbidity score. BMC Cancer. 2004;4:94 http://www.biomedcentral.com/1471-2407/4/94. Accessed December 5, 2010.. [CrossRef] [PubMed]
 

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References

Bernasconi M, Tamm M, Bingisser R, et al. Midregional proatrial natriuretic peptide predicts survival in exacerbations of COPD. Chest. 2011;1401:91-99. [CrossRef] [PubMed]
 
Hall WH, Ramachandran R, Narayan S, Jani AB, Vijayakumar S. An electronic application for rapidly calculating Charlson comorbidity score. BMC Cancer. 2004;4:94 http://www.biomedcentral.com/1471-2407/4/94. Accessed December 5, 2010.. [CrossRef] [PubMed]
 
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