Nt-probnp as a Prognostic Marker in Different Gold Classes in Patients with Chronic Obstructive Pulmonary Disease (COPD)

Abstract

Background: Chronic obstructive pulmonary disease (COPD) was the fifth leading cause for early death and disability in 2020 with approximately 2.75 million deaths per year, which was 4.8%in total from the general mortality. Right ventricular hypertrophy with preserved systolic function is the most common finding in patients with COPD. The development of pulmonary hypertension leads to DV (right ventricle) dilatation and DV heart failure during the course of the disease. Material and methods: The design of the research was a prospective-clinical cross-sectional study as we analyzed 94 patients with COPD. All patients were divided in groups according to the degree of obstruction and classified by the GOLD classification system into four groups from GOLD 1 – GOLD4. All of our patients were analyzed thoroughly on admission and during hospital stay. ECG was made, Nt-proBNP analysis and basic and advanced echocardiography evaluation. Natriuretic peptides were measured and processed by commercially available assays with excellent precision where cut-off value was 125pg/ml. Echo analysis was done by Vivid 7 echo machine with a special feature to right heart chamber characteristics. Results: In terms of risk factors, hypertension, diabetes mellitus and hyperlipidemia were examined in all 94 patients in our study. Arterial hypertension was present in half of the patients, 51.06%. Diabetes mellitus was present in 19.15% of analyzed patients. The analysis of Nt-proBNP level in our study showed that the average value of this natriuretic peptide was above reference range and it was 236.27pg/ml. The highest average values of NT-proBNP were registered in GOLD class 3, while the lowest average and maximum value of NT-proBNP was found in GOLD class 2. According to the results of the Tukey post-hoc test, there was a statistically significant difference in Nt-proBNP levels between GOLD class 2 and GOLD class 3. The average values of Nt-proBNP in the group of patients with acute exacerbation was far higher than in the group of chronically stable patients. The difference between the two groups was 3.5 times in GOLD class 3 and approximately 2 times in GOLD class 4. Conclusion: BNP and NT-proBNP are natriuretic peptides that are secreted under conditions of cardiac stress and weakness. They are established biomarkers and are listed in the guidelines for chronic heart failure as they are quantitative markers used for diagnosis and risk stratification. Still, more studies with a larger number of patients are needed to confirm the role of Nt-proBNP in patients with COPD in different stages of GOLD and progression of the disease.