J Korean Med Sci.  2015 Apr;30(4):442-449. 10.3346/jkms.2015.30.4.442.

One-year Prognosis and the Role of Brain Natriuretic Peptide Levels in Patients with Chronic Cor Pulmonale

• Park SY
• Lee CY
• Kim C
• Jang SH
• Park YB
• Park S
• Hwang YI
• Lee MG
• Jung KS
• Kim DG

• KMID: 2164452
• DOI: http://doi.org/10.3346/jkms.2015.30.4.442

Abstract

Data on the clinical outcomes and role of brain natriuretic peptide (BNP) levels in patients with chronic cor pulmonale are limited. A total of 69 patients with chronic cor pulmonale, admitted for dyspnea (January 2007 to September 2011) to three university hospitals, were retrospectively reviewed. All of the patients had right ventricular (RV) dysfunction on echocardiography. The median age was 70.0 yr, and chronic obstructive pulmonary disease (40.6%) and tuberculosis-destroyed lung (TDL, 27.5%) were the leading causes of chronic cor pulmonale. At the 1-yr follow-up, the mortality rate was 15.9%, and the readmission rate was 53.7%; patients with TDL had higher mortality (31.6% vs. 10.0%; P = 0.059) and readmission rates (78.9% vs. 43.8%; P = 0.009) than those with non-TDL diseases. The area under the receiver operating characteristic curve for admission BNP levels to predict readmission was 0.788 (95% confidence interval [CI], 0.673-0.904), and the sensitivity and specificity of the cut-off value were 80.6% and 77.4%, respectively. In multivariate analysis, high admission BNP levels were a significant risk factor for subsequent readmission (hazard ratio, 1.049; 95% CI, 1.005-1.094). Additionally, admission BNP levels were well correlated with cardiac troponin I (r = 0.558), and delta BNP also correlated with delta RV systolic pressure (n = 25; r = 0.562). In conclusion, among hospitalized patients with chronic cor pulmonale, admission high BNP levels are a significant risk factor for subsequent readmission. Therefore, more intensive monitoring and treatment are needed in patients with higher BNP levels.

Keyword

Admission; Natriuretic Peptide, Brain; Pulmonary Heart Disease; Outcome

MeSH Terms

Aged
Chronic Disease
Female
Humans
Male
Middle Aged
Natriuretic Peptide, Brain/*blood
Patient Readmission
Prognosis
Pulmonary Disease, Chronic Obstructive/complications
Pulmonary Heart Disease/*blood/mortality
ROC Curve
Retrospective Studies
Tuberculosis, Pulmonary/complications
Natriuretic Peptide, Brain

Figure

• 

  Fig. 1 Flow chart for the enrolled subjects. UTI, urinary tract infection.

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  Fig. 2 Correlation between changes in BNP levels and RV systolic pressure. There was a significant correlation between admission BNP levels and cardiac troponin I levels (n = 69; by Spearman's correlation; A) and a significant correlation between delta BNP and delta RV systolic pressure (n = 25; by Spearman's correlation; B). BNP, brain natriuretic peptide; RV, right ventricular.

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  Fig. 3 Receiver operating characteristic curve for admission BNP levels to predict subsequent readmission within 1 yr. The cut-off value was estimated to be 709.1 pg/mL, and the sensitivity, specificity, positive predictive value, and negative predictive values were 80.6%, 77.4%, 80.6%, and 77.4%, respectively. AUC, area under the curve; BNP, brain natriuretic peptide.

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  Fig. 4 Kaplan-Meier curve for subsequent readmission. Patients with high BNP levels have a shorter time interval before subsequent readmission after hospital discharge than those with low BNP levels (log-rank, χ2=21.893 and P < 0.001). BNP, brain natriuretic peptide.

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