title: Prognostic utility of NT-proBNP in acute exacerbations of chronic pulmonary diseases.
abstract: BACKGROUND
  The prognostic value of NT-proBNP levels in patients admitted to hospital due to acute exacerbations of chronic pulmonary diseases (CPDs) is unknown.
  
  
  METHODS
  Internal Medicine units at two general hospitals.
  
  
  METHODS
  NT-proBNP levels were obtained within 72 h after admission in 192 consecutive patients with acute exacerbations of CPDs and no history of heart failure or diuretic treatment. Clinical characteristics and main outcomes were assessed over a 12-month follow-up. NT-proBNP cut-points for outcomes were obtained by ROC (receiver operating characteristics) curve analysis.
  
  
  RESULTS
  Chronic obstructive lung disease (69.3%) and chronic asthma (22.4%) were the most prevalent CPDs, and non-pneumonic acute respiratory infection (72.4%) and pneumonia (22.9%) were the most frequent causes of exacerbation. Atrial flutter or fibrillation rate was 11%. During the one-year follow-up period, 22 patients died, 42 were re-admitted, 46 received new long-term oxygen therapy, and 39 received new diuretic treatment. NT-proBNP values correlated with hospitalisation days. NT-proBNP values over 587.9 pg/ml were associated with significantly raised one-year mortality (OR=3.90; 95% IC 1.46-10.47; p=0.006) and over 782.2 pg/ml with cardio-pulmonary deaths (OR=6.38; 95% IC 1.91-21.3; p=0.002). That association persisted after adjustment for age, gender, creatinine levels and cardiac rhythm. NT-proBNP values over 628.7 pg/ml were associated with significantly higher probability of new diuretic treatment (OR=4.38; IC 95% 2.07-9.25; p<0.001). The negative predictive values for these cut-points ranged from 89% to 97%.
  
  
  CONCLUSIONS
  NT-proBNP levels below 587.9 pg/ml in patients with acute exacerbations of CPD were associated with favourable one-year outcomes.
authors.affiliation: Internal Medicine Service, Hospital Virgen de la Luz, Cuenca, Spain.
authors.forename: Araceli Molina
authors.initials: AM
authors.lastname: Medina
authors.forename: Marta Sanchez
authors.initials: MS
authors.lastname: Marteles
authors.forename: Elisa Bermejo
authors.initials: EB
authors.lastname: Sáiz
authors.forename: Sandra Serrano
authors.initials: SS
authors.lastname: Martínez
authors.forename: Fernando Ruiz
authors.initials: FR
authors.lastname: Laiglesia
authors.forename: José A Nieto
authors.initials: JA
authors.lastname: Rodríguez
authors.forename: Juan I
authors.initials: JI
authors.lastname: Pérez-Calvo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000188:drug therapy / Q000503:physiopathology; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008171:Lung Diseases / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood / Q000627:therapeutic use*; D010446:Peptide Fragments / Q000097:blood / Q000627:therapeutic use*; D011014:Pneumonia / Q000150:complications; D015995:Prevalence; D011379:Prognosis; D011498:Protein Precursors; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000503:physiopathology; D012372:ROC Curve; D012141:Respiratory Tract Infections / Q000150:complications; D012720:Severity of Illness Index
chemical_list: D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain