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

Saraschandra Vallabhajosyula, Toufik Mahfood Haddad, Pranathi R. Sundaragiri, Anas A. Ahmed, Muhammad Sarfraz Nawaz, Hamza A.A. Rayes, Harish C. Devineni, Arun Kanmanthareddy, Dustin A. McCann, Christopher S. Wichman, Ariel M. Modrykamien, Lee E. Morrow

Research output: Contribution to journalArticle

2 Citations (Scopus)

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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)635-644
Number of pages10
JournalJournal of Intensive Care Medicine
Volume33
Issue number11
DOIs
StatePublished - Nov 1 2018

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Brain Natriuretic Peptide
Noninvasive Ventilation
Left Ventricular Function
Chronic Obstructive Pulmonary Disease
Artificial Respiration
Length of Stay
Stroke Volume
Intensive Care Units
Kidney
Hospital Mortality
Comorbidity
Multivariate Analysis
Retrospective Studies

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

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. / Vallabhajosyula, Saraschandra; Haddad, Toufik Mahfood; Sundaragiri, Pranathi R.; Ahmed, Anas A.; Nawaz, Muhammad Sarfraz; Rayes, Hamza A.A.; Devineni, Harish C.; Kanmanthareddy, Arun; McCann, Dustin A.; Wichman, Christopher S.; Modrykamien, Ariel M.; Morrow, Lee E.

In: Journal of Intensive Care Medicine, Vol. 33, No. 11, 01.11.2018, p. 635-644.

Research output: Contribution to journalArticle

Vallabhajosyula, S, Haddad, TM, Sundaragiri, PR, Ahmed, AA, Nawaz, MS, Rayes, HAA, Devineni, HC, Kanmanthareddy, A, McCann, DA, Wichman, CS, Modrykamien, AM & Morrow, LE 2018, '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', Journal of Intensive Care Medicine, vol. 33, no. 11, pp. 635-644. https://doi.org/10.1177/0885066616682232
Vallabhajosyula, Saraschandra ; Haddad, Toufik Mahfood ; Sundaragiri, Pranathi R. ; Ahmed, Anas A. ; Nawaz, Muhammad Sarfraz ; Rayes, Hamza A.A. ; Devineni, Harish C. ; Kanmanthareddy, Arun ; McCann, Dustin A. ; Wichman, Christopher S. ; Modrykamien, Ariel M. ; Morrow, Lee E. / 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. In: Journal of Intensive Care Medicine. 2018 ; Vol. 33, No. 11. pp. 635-644.
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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. Conclusion: 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.",
author = "Saraschandra Vallabhajosyula and Haddad, {Toufik Mahfood} and Sundaragiri, {Pranathi R.} and Ahmed, {Anas A.} and Nawaz, {Muhammad Sarfraz} and Rayes, {Hamza A.A.} and Devineni, {Harish C.} and Arun Kanmanthareddy and McCann, {Dustin A.} and Wichman, {Christopher S.} and Modrykamien, {Ariel M.} and Morrow, {Lee E.}",
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T1 - Role of B-Type Natriuretic Peptide in Predicting In-Hospital Outcomes in Acute Exacerbation of Chronic Obstructive Pulmonary Disease With Preserved Left Ventricular Function

T2 - A 5-Year Retrospective Analysis

AU - Vallabhajosyula, Saraschandra

AU - Haddad, Toufik Mahfood

AU - Sundaragiri, Pranathi R.

AU - Ahmed, Anas A.

AU - Nawaz, Muhammad Sarfraz

AU - Rayes, Hamza A.A.

AU - Devineni, Harish C.

AU - Kanmanthareddy, Arun

AU - McCann, Dustin A.

AU - Wichman, Christopher S.

AU - Modrykamien, Ariel M.

AU - Morrow, Lee E.

PY - 2018/11/1

Y1 - 2018/11/1

N2 - 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. Conclusion: 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.

AB - 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. Conclusion: 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.

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