TY - JOUR
T1 - NT-proBNP in stable COPD and future exacerbation risk
T2 - Analysis of the SPIROMICS cohort
AU - Labaki, Wassim W.
AU - Xia, Meng
AU - Murray, Susan
AU - Curtis, Jeffrey L.
AU - Barr, R. Graham
AU - Bhatt, Surya P.
AU - Bleecker, Eugene R.
AU - Hansel, Nadia N.
AU - Cooper, Christopher B.
AU - Dransfield, Mark T.
AU - Wells, J. Michael
AU - Hoffman, Eric A.
AU - Kanner, Richard E.
AU - Paine, Robert
AU - Ortega, Victor E.
AU - Peters, Stephen P.
AU - Krishnan, Jerry A.
AU - Bowler, Russell P.
AU - Couper, David J.
AU - Woodruff, Prescott G.
AU - Martinez, Fernando J.
AU - Martinez, Carlos H.
AU - Han, Mei Lan K.
N1 - Funding Information:
This analysis was also supported by National Institutes of Health grants R01HL122438 , R01HL126838 , T32HL007749 and K24HL138188 .
Funding Information:
RGB reports a grant from the Alpha-1 Foundation , royalties from UpToDate and travel support from the COPD Foundation.
Funding Information:
JLC reports research support from the NIH , NHLBI , MedImmune , and the Department of Veterans Affairs .
Funding Information:
VEO reports receiving funding from the National Institutes of Health (NIH) National Heart, Lung, and Blood Institute (NHLBI) in the form of a K08 training award, NIH HL118128 . He also reports consultancy fees from CSL Behring.
Funding Information:
CBC reports grants from Equinox Health Clubs , personal fees from Equinox Health Clubs, grants from Amgen , personal fees from PulmonX, personal fees from Boehringer Ingelheim, personal fees from GlaxoSmithKline, grants from Spiration , personal fees from Spiration, outside the submitted work. CBC also works part-time on scientific engagement for the GlaxoSmithKline Global Respiratory Franchise.
Funding Information:
MKH reports grants from NIH , grants from Foundation for the NIH and grants from COPD Foundation, during the conduct of the study. She also reports consulting for Boehringer Ingelheim, GlaxoSmithKline, Novartis and AstraZeneca, royalties from UpToDate and research support from Novartis.
Funding Information:
MKH reports grants from NIH, grants from Foundation for the NIH and grants from COPD Foundation, during the conduct of the study. She also reports consulting for Boehringer Ingelheim, GlaxoSmithKline, Novartis and AstraZeneca, royalties from UpToDate and research support from Novartis.
Funding Information:
SPB is supported by NIH grant K23HL133438 .
Funding Information:
MTD has received grants from NIH and the Department of Defense , consulting fees from AstraZeneca, Boerhinger Ingelheim, Genentech, GlaxoSmithKline, and PneumRx/BTG and contracted clinical trial funding from AstraZeneca, Boerhinger Ingelheim, GlaxoSmithKline, Yungjin, PneumRx/BTG, Pulmonx, Novartis, and Boston Scientific.
Publisher Copyright:
© 2018 Elsevier Ltd
PY - 2018/7
Y1 - 2018/7
N2 - 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, FEV1 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.
AB - 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, FEV1 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.
KW - Brain natriuretic peptides
KW - Cardiovascular disease
KW - Chronic obstructive pulmonary disease
KW - Respiratory exacerbation
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U2 - 10.1016/j.rmed.2018.06.005
DO - 10.1016/j.rmed.2018.06.005
M3 - Article
C2 - 29957287
AN - SCOPUS:85048542620
SN - 0954-6111
VL - 140
SP - 87
EP - 93
JO - Respiratory Medicine
JF - Respiratory Medicine
ER -