title: Midregional proatrial natriuretic peptide predicts survival in exacerbations of COPD.
abstract: 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 FEV(1)% 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), Paco(2) (P < .0001), and MR-proANP (P = .001) predicted mortality in the univariate Cox-regression model. Both MR-proANP and Paco(2) 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.
authors.affiliation: Clinic for Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel, Basel.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bernasconi
authors.affiliation: Clinic for Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel, Basel.
authors.forename: Michael
authors.initials: M
authors.lastname: Tamm
authors.affiliation: Department for Emergency Medicine, University Hospital Basel, Basel.
authors.forename: Roland
authors.initials: R
authors.lastname: Bingisser
authors.affiliation: Clinic for Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel, Basel.
authors.forename: David
authors.initials: D
authors.lastname: Miedinger
authors.affiliation: Clinic for Internal Medicine, University Hospital Basel, Basel.
authors.forename: Jörg
authors.initials: J
authors.lastname: Leuppi
authors.affiliation: Clinic for Internal Medicine, Hospital Aarau, Aarau, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Müller
authors.affiliation: Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Basel, Basel.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Christ-Crain
authors.affiliation: Clinic for Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel, Basel. Electronic address: stolzd@uhbs.ch.
authors.forename: Daiana
authors.initials: D
authors.lastname: Stolz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007118:Immunoassay; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000401:mortality*; D020127:Recovery of Function; D015996:Survival Rate / Q000639:trends; D013557:Switzerland / Q000453:epidemiology; D013997:Time Factors
chemical_list: D015415:Biomarkers; C552580:midregional pro-atrial natriuretic peptide, human; D009320:Atrial Natriuretic Factor