High NT-proBNP in COPD May Predict Respiratory Exacerbations

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NT-proBNP may be an independent predictor of respiratory exacerbations in patients with COPD even without overt cardiovascular disease.

In patients with chronic obstructive pulmonary disease (COPD), baseline N-terminal
pro-brain natriuretic peptide (NT-proBNP) was an independent predictor of respiratory exacerbations even without  overt cardiovascular disease (CVD), according to an analysis of data from the multicenter longitudinal Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS; ClinicalTrials.gov Identifier: NCT01969344) published in Respiratory Medicine.

Participants from the SPIROMICS cohort between age 40 and 80 with COPD Global initiative for chronic Obstructive Lung Disease (GOLD) stages 1 to 4 were evaluated. The link between baseline NT-proBNP and incident COPD exacerbations within 1 year of follow-up was examined, with adjustments made for age, gender, race, current smoking status/smoking history, body mass index, forced expiratory volume in 1 second (FEV1) percent predicted, exacerbation history, COPD Assessment Test score, total lung capacity on chest computed tomography, and CVD (defined as the occurrence of any coronary artery disease, myocardial infarction, or congestive heart failure).

Of a total of 1051 participants (mean age, 66.1; 41.4% women), mean
NT-proBNP was 608.9 pg/mL. The highest mean NT-proBNP was reported in patients in GOLD stage D (758.4 pg/mL). Overall, 268 participants experienced ≥1 COPD exacerbation. In fact, 1 standard deviation increase in baseline NT-proBNP was significantly associated with a 13% increased risk for incident COPD exacerbations (incident risk ratio: 1.13; 95% CI, 1.06-1.19; P <.0001). This association was maintained in participants both with and without CVD.

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The researchers concluded that the effect of detection and treatment of early CV dysfunction on exacerbations in patients with COPD warrants additional investigation. Exploring the relationship between cardiac and pulmonary variables in COPD will help to better our understanding of the risk for exacerbations in susceptible individuals.

Disclosures: Several authors report financial relationships with pharmaceutical companies, including Amgen, Boehringer-Ingelheim, GlaxoSmithKline, and others.


Labaki WW, Xia M, Murray S, et al. NT-proBNP in stable COPD and future exacerbation risk: analysis of the SPIROMICS cohort. Respir Med. 2018;140:87-93.