B-type natriuretic peptide and COPD in the Emergency Department
AbstractIntroduction: The aim of this study was to evaluate, in patients with chronic obstructive pulmonary disease (COPD) and arrived to the emergency department (ED) with dyspnea / hypoxia, the existence of possible correlations between blood levels of B-type natriuretic peptide (NT-proBNP) and presence of heart failure [HF]), mortality, outcome of the ED visit (discharge, ospitalization,death), and length of post-ED hospital stays.
Materials and methods: Clinical history, medical examination and blood levels of NT-proBNP were perfomed in all patients selected to our emergency department with the above symptoms between December 2006 and December 2008. Emergency department and hospital charts for these patients were later retrospectively reviewed to identify patients diagnosed with COPD.
Results: A total of 546 patients (mean age 77 years, 52% women) had final diagnoses of COPD (with or without HF). Eight died in the ED, 104 were discharged after the ED visit, and 424 were hospitalized. Hospitalizations were longer for patients with COPD alone (21 days vs. 13 days for COPD + HF). Mortality among hospitalized patients was 9.7%. Seventy-six percent of the patients had elevated blood levels of NT-proBNP (>450ng/L) in the ED. Most of these patients (54%) had COPD and HF; the others (22%) had COPD alone (p < 0.01). Low levels of NT-proBNP (<450ng/L) were more frequent in patients with simple COPD who were discharged after the ED visit (89/ 546). In this group, 25/89 returned to the ED after more than 60 days; 17% had simple COPD, and 10/25 were hospitalized. Elevated blood NT-proBNP levels were significantly associated with mortality (p < 0.001).
Discussion: The findings of the present study indicate that HF is the main cause of dyspnea and hypoxia among patients with COPD who present to the ED with these symptoms. High blood levels of NT-proBNP on ED admission can alert ED physicians to the presence of HF, allowing them to prescribe appropriate treatment and make more informed decisions regarding the need for hospitalization. Low levels of NT-proBNP appear to be associated with simple COPD and low-risk that may be manageable on an outpatient basis. Measurement of NT-proBNP levels in dyspneic patients presenting to the ER is helpful for making a correct diagnosis and identifying appropriate management strategies.
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Copyright (c) 2013 Tiziano Minora, Pietro Marino
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