Influence of effective noninvasive positive pressure ventilation on inflammatory and cardiovascular biomarkers in stable hypercapnic COPD patients.
BACKGROUND
Noninvasive positive pressure ventilation (NPPV) using effective pressure levels to reduce chronic hypercapnia improves survival in stable hypercapnic COPD. However, the underlying mechanisms remain unclear. This study investigated the influence of effective NPPV on a panel of cytokines and established cardiovascular biomarkers.


METHODS
Peripheral blood samples were drawn before and three months after the initiation of NPPV and analyzed by flow cytometric bead array and ELISA.


RESULTS
Twenty COPD patients (forced expiratory volume in 1 s 31 ± 17% predicted) were included. NPPV (inspiratory positive airway pressure 23 ± 4 mbar; breathing frequency 17 ± 2/min) significantly improved arterial carbon dioxide pressure (PaCO2), both during daytime spontaneous breathing (p = 0.005) and nighttime ventilation (p < 0.001). Serum interleukin (IL)-10 levels were slightly reduced (p = 0.016), whereas IL-1 (p = 0.073) and IL-12 (p = 0.089) showed only a tendency towards change over time. Pro-brain natriuretic peptide (proBNP) significantly decreased by a mean of 578 ± 1332 ng/L after three months' NPPV (p = 0.017 vs baseline). No other significant changes in cardiovascular biomarkers occurred. The decrease in PaCO2 during daytime spontaneous breathing was positively correlated with the reduction in proBNP (correlation coefficient 0.613; p = 0.0197).


CONCLUSIONS
Effective NPPV impacts on systemic inflammation in COPD patients. Furthermore, reductions in PaCO2 during NPPV were associated with decreases in proBNP levels. Future studies are needed to clarify these findings in a larger cohort of COPD patients.


BACKGROUND
DRKS00007644 (German Clinical Trials Register; https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=resultsExt).
Department of Cardiology, Pneumology, Angiology and Intensive Care Medicine, University Hospital Aachen, Germany. Electronic address: mdreher@ukaachen.de.
Michael
M
Dreher
Department of Cardiology and Angiology I, University Heart Center Freiburg, Germany.
Lisa
L
Schulte
Department of Cardiology, Pneumology, Angiology and Intensive Care Medicine, University Hospital Aachen, Germany.
Tobias
T
Müller
Department of Pneumology, University Hospital Freiburg, Germany.
Emelie
E
Ekkernkamp
Department of Cardiology and Angiology I, University Heart Center Freiburg, Germany.
Andreas
A
Zirlik
D000368:Aged; D015415:Biomarkers / Q000032:analysis; D002245:Carbon Dioxide / Q000097:blood*; D002318:Cardiovascular Diseases / Q000097:blood / Q000503:physiopathology*; D002908:Chronic Disease; D016207:Cytokines / Q000097:blood; D005260:Female; D005434:Flow Cytometry; D005541:Forced Expiratory Volume; D006801:Humans; D006935:Hypercapnia / Q000097:blood*; D007249:Inflammation / Q000097:blood; D007378:Interleukins / Q000097:blood; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000009:adverse effects / Q000379:methods*; D010313:Partial Pressure; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000503:physiopathology* / Q000628:therapy*
D015415:Biomarkers; D016207:Cytokines; D007378:Interleukins; D002245:Carbon Dioxide
Cardiovascular inflammation; Chronic obstructive pulmonary disease; Noninvasive positive pressure ventilation