SESSION TITLE: COPD and the Heart
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Monday, October 26, 2015 at 01:30 PM - 02:30 PM
PURPOSE: The cardiac peptides B-type natriuretic peptide (BNP) and the N-terminal fragment of its prohormone pro-BNP (NT-proBNP) are established biomarkers of heart failure (HF). They are primarily used for diagnosis, risk stratification and management of HF. The natriuretic peptides (NP) can be elevated in patients with chronic obstructive pulmonary disease (COPD) without HF, likely originating from both sides of the heart. Cor-pulmonale, pulmonary hypertension or hypoxemia represent important stimuli for the release of NP from the right heart. In stable COPD patients, increased levels of NP have been associated with poorer long-term survival. The goal of this study was to correlate pro-BNP levels with outcomes in patients admitted with acute exacerbation of COPD (AECOPD).
METHODS: Retrospective observational study of patients admitted to the intensive care unit (ICU) with AECOPD from January 2012 to December 2013. Inclusion criteria: available spirometry and echocardiogram within 6 months, diagnosis of COPD and admission pro- BNP. Patients with impaired right or left heart function were excluded. Patients with elevated pro-BNP were compared to patients with normal levels. Demographic data, arterial blood gases, BMI, RVSP were obtained. Primary outcomes included NIPPV use and failure and ICU length of stay (LOS). Secondary outcomes were hospital LOS and mortality.
RESULTS: 310 patients were admitted to ICU with AECOPD, 45 (15%) met inclusion criteria, (24= normal pro-BNP and 21=increased levels). Elderly patients were more common in pro-BNP normal group. We found no differences for GOLD stage, home oxygen requirement and basic metabolic panel between the groups. 35 patients received NIPPV, 12 mechanical ventilation (APACHE II 13.7 versus 16.4(p=ns) respectively. No difference for NIPPV use (19/24 versus 16/21 p=1.0), NIPPV failure(3/24 versus 3/21 p=1.0), NIPPV days(2.5±2.4 versus 3.5±3.8 p=0.35), MV days(10.3±12.89 versus 18.3±32.9 p=0.53) or ICULOS (3.95±4.2 versus 5.15±6.279 p=0.44). Hospital LOS (11.33±4.9 versus 16.5+23.189p=0.29) and mortality (1/24 versus 1/21p=1.0) was similar between groups.
CONCLUSIONS: In ICU patients with AECOPD, pro-BNP levels are not predictive of need for NIPPV or NIPPV failure/utilization. There is no differences in LOS or mortality for patients with normal when compared to elevated pro-BNP.
CLINICAL IMPLICATIONS: Utility of pro-BNP in patients admitted with AECOPD and normal cardiac function is questionable and cannot be recommended at this time.
DISCLOSURE: The following authors have nothing to disclose: Varalaxmi Nannaka, Gilda Diaz-Fuentes, Sindhaghatta Venkatram, Muhammad Adrish
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