title: Role of B-Type Natriuretic Peptide in Predicting In-Hospital Outcomes in Acute Exacerbation of Chronic Obstructive Pulmonary Disease With Preserved Left Ventricular Function: A 5-Year Retrospective Analysis.
abstract: BACKGROUND
  The role of B-type natriuretic peptide (BNP) is less understood in the risk stratification of patients with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD), especially in patients with normal left ventricular ejection fraction (LVEF).
  
  
  METHODS
  This retrospective study from 2008 to 2012 evaluated all adult patients with AECOPD having BNP levels and available echocardiographic data demonstrating LVEF ≥40%. The patients were divided into groups 1, 2, and 3 with BNP ≤ 100, 101 to 500, and ≥501 pg/mL, respectively. A subgroup analysis was performed for patients without renal dysfunction. Outcomes included need for and duration of noninvasive ventilation (NIV) and mechanical ventilation (MV), NIV failure, reintubation at 48 hours, intensive care unit (ICU) and total length of stay (LOS), and in-hospital mortality. Two-tailed P < .05 was considered statistically significant.
  
  
  RESULTS
  Of the total 1145 patients, 550 (48.0%) met our inclusion criteria (age 65.1 ± 12.2 years; 271 [49.3%] males). Groups 1, 2, and 3 had 214, 216, and 120 patients each, respectively, with higher comorbidities and worse biventricular function in higher categories. Higher BNP values were associated with higher MV use, NIV failure, MV duration, and ICU and total LOS. On multivariate analysis, BNP was an independent predictor of higher NIV and MV use, NIV failure, NIV and MV duration, and total LOS in groups 2 and 3 compared to group 1. B-type natriuretic peptide continued to demonstrate positive correlation with NIV and MV duration and ICU and total LOS independent of renal function in a subgroup analysis.
  
  
  CONCLUSIONS
  Elevated admission BNP in patients with AECOPD and normal LVEF is associated with worse in-hospital outcomes and can be used to risk-stratify these patients.
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.|2 Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Laboratory, Mayo Clinic, Rochester, MN, USA.
authors.forename: Saraschandra
authors.initials: S
authors.lastname: Vallabhajosyula
authors.affiliation: 3 Division of Cardiovascular Diseases, Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE, USA.
authors.forename: Toufik Mahfood
authors.initials: TM
authors.lastname: Haddad
authors.affiliation: 4 Division of Hospital Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Pranathi R
authors.initials: PR
authors.lastname: Sundaragiri
authors.affiliation: 5 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Tufts University School of Medicine, Boston, MA, USA.
authors.forename: Anas A
authors.initials: AA
authors.lastname: Ahmed
authors.affiliation: 6 Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
authors.forename: Muhammad Sarfraz
authors.initials: MS
authors.lastname: Nawaz
authors.affiliation: 7 Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE, USA.
authors.forename: Hamza A A
authors.initials: HAA
authors.lastname: Rayes
authors.affiliation: 7 Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE, USA.
authors.forename: Harish C
authors.initials: HC
authors.lastname: Devineni
authors.affiliation: 3 Division of Cardiovascular Diseases, Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE, USA.
authors.forename: Arun
authors.initials: A
authors.lastname: Kanmanthareddy
authors.affiliation: 8 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE, USA.
authors.forename: Dustin A
authors.initials: DA
authors.lastname: McCann
authors.affiliation: 9 Division of Clinical Research and Evaluative Sciences, Creighton University School of Medicine, Omaha, NE, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Wichman
authors.affiliation: 10 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Baylor University Medical Center, Dallas, TX, USA.
authors.forename: Ariel M
authors.initials: AM
authors.lastname: Modrykamien
authors.affiliation: 8 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE, USA.|11 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, USA.
authors.forename: Lee E
authors.initials: LE
authors.lastname: Morrow
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D003422:Critical Care; D018450:Disease Progression; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D063087:Noninvasive Ventilation; D063868:Patient Outcome Assessment; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood* / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D012121:Respiration, Artificial; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D013997:Time Factors; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
keywords: B-type natriuretic peptide; chronic obstructive pulmonary disease; heart failure with preserved ejection fraction; pulmonary vascular disease; right heart failure