Chest
Original ResearchCOPDMidregional Proatrial Natriuretic Peptide Predicts Survival in Exacerbations 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).