Role of N-terminal pro B-type natriuretic peptide in acute exacerbation of chronic obstructive pulmonary disease

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a major public health problem. Recognition of comorbid heart dysfunction in such patients is often difficult. The aim of this work is to evaluate the role of N-terminal pro B-type natriuretic peptide (Nt-pro BNP) in AECOPD with respiratory failure. This study was conducted on 20 patients with AECOPD and respiratory failure. All patients were subjected to history taking, clinical examination, routine laboratory investigations, arterial blood gases analysis, echocardiography and estimation of plasma level of NT-pro BNP. Patients were classified into 3 groups: Group I: those without heart dysfunction (40%), Group II: those with diastolic heart failure (40%), and Group III: those with systolic heart failure (20%). NT-pro BNP mean ± SD in group I was 673.38 ± 416.02, in group II 1962 ± 847.88, and in group III 6776.75 ± 1433.59 pg/ml. There was a statistically significant difference between the three groups (p = 0.001). NT-pro BNP showed a statistically significant inverse correlation with pH (p = 0.005), ejection fraction (p = 0.007) and a direct one with both left ventricular systolic (p = 0.008) and diastolic (p = 0.016) dimensions and E/A (p = 0.016). The NT-pro BNP significantly decreased after recovery from AECOPD (p = 0.030). The receiver operating characteristic curve demonstrated a ruling out of LV dysfunction in AECOPD of a sensitivity of 100% and a specificity of 60%; and a ruling in of a sensitivity of 48% and a specificity of 67%. Plasma BNP is usually elevated in AECOPD and is related to right or left ventricular systolic or diastolic dysfunction.