Chest
Volume 140, Issue 1, July 2011, Pages 91-99
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Original Research
COPD
Midregional Proatrial Natriuretic Peptide Predicts Survival in Exacerbations of COPD

https://doi.org/10.1378/chest.10-1353Get rights and content

Background

Recently, the use of systemic biomarkers to monitor and assess the clinical evolution of respiratory disease has gained interest. We investigated whether midregional proatrial natriuretic peptide (MR-proANP) predicts survival in patients with COPD when they are admitted to the hospital for exacerbation.

Methods

One hundred sixty-seven patients (mean age 70 years old, 75 men) admitted to the hospital for exacerbation were followed up for 2 years. MR-proANP was measured on admission, after 14 days, and at 6 months. The predictive value of clinical, functional, and laboratory parameters on admission were assessed by Cox regression analyses. The time to death was analyzed by Kaplan-Meier survival curves.

Results

MR-proANP level was significantly higher on admission for exacerbation, compared with recovery and stable state (P = .004 for the comparison among all time points). MR-proANP correlated with the Charlson condition and age-related score (P < .0001), left ventricular ejection fraction (P < .0001), C-reactive protein (P = .037), and FEV1% predicted (P = .004). MR-proANP levels were similar in patients requiring ICU treatment and in those treated in the medical ward (P = .086). Thirty-seven patients (22%) died within 2 years. MR-proANP levels were higher in nonsurvivors compared with survivors (median [interquartile range] 185 pmol/L [110–286] vs 92 pmol/L [56–158], P < .001). Mortality was higher across MR-proANP quartiles (log rank P < .0001). Charlson condition and age-related score (P = .001), Paco2 (P < .0001), and MR-proANP (P = .001) predicted mortality in the univariate Cox-regression model. Both MR-proANP and Paco2 were independent predictors of mortality in the multivariate Cox regression model.

Conclusions

MR-proANP at exacerbation is associated with 2-year long-term survival in patients with exacerbation of COPD.

Section snippets

Setting and Study Population

This prospective cohort study assessed short- and long-term mortality in patients with exacerbations of COPD recruited in the Procalcitonin Guidance of Antibiotic Therapy in Chronic Obstructive Lung Disease (ProCOLD) study.24 Data were analyzed from 167 patients admitted to the ED of the University Hospital Basel, Switzerland, for exacerbation of COPD from November 2003 to March 2005. A complete description has been reported elsewhere.24 In brief, the primary end point of this study was to

Results

Baseline characteristics of the 167 patients, including classification according to the GOLD stage at the recovery phase of the disease, are presented in Table 1. Overall, 116 patients (69.5%) had relevant comorbidities. Sputum cultures grew bacteria in 65 cases (38.9%). Echocardiography results were available for 123 patients (73.7%). A total of 38 patients (22.8%) demonstrated clinically relevant pulmonary arterial hypertension. In 12 cases (7.2%), echocardiography showed decreased left

Discussion

In this study, we report three major findings: First, MR-proANP plasma levels are elevated in patients hospitalized for exacerbation of COPD compared with during the recovery and the stable phase of the disease. Second, MR-proANP levels at exacerbation are increased in long-term nonsurvivors compared with survivors, and the probability of survival markedly differs across MR-proANP quartiles. Third, MR-proANP and Paco2 are independent predictors of 2-year survival in patients with COPD.

Several

Conclusions

In conclusion, our results support the long-term prognostic value of MR-proANP plasma level on hospital admission in patients with exacerbation of COPD. Studies are needed to evaluate whether an MR-proANP guided-approach is able to influence survival in the COPD population.

Acknowledgments

Author contributions: All authors reviewed and approved the final manuscript.

Dr Bernasconi: contributed to data analysis and writing of the manuscript.

Dr Tamm: contributed to the study concept, study design, data analysis, and drafting the manuscript for important intellectual content.

Dr Bingisser: contributed to patient recruitment and drafting the manuscript for important intellectual content.

Dr Miedinger: contributed to patient recruitment and drafting the manuscript for important

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    Funding/Support: Dr Stolz was supported by grants from the Swiss National Foundation [PP00P3_128412/1]. Dr Christ-Crain was supported by grants from the Swiss National Foundation [PP00P3_123346]. Additional funding was granted by the Clinic of Pulmonary Medicine and Clinic of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Basel, Switzerland.

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

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