Utility of NT-proBNP in predicting short-term outcomes in acute exacerbation of COPD without overt cardiac involvement
DOI:
https://doi.org/10.64171/JAMS.2026.6.2.12-16Keywords:
Chronic Obstructive Pulmonary Disease (COPD), Acute Exacerbation of COPD (AECOPD), NT-proBNP, Biomarkers, Risk stratification, Intensive Care Unit (ICU) admission, Ventilatory support, Arterial Blood Gas (ABG)Abstract
Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with substantial morbidity, mortality, prolonged hospitalization, and increased healthcare burden. Early identification of high-risk patients remains a clinical challenge because the severity of exacerbations often varies widely between individuals. Biomarkers capable of predicting disease severity and adverse outcomes may help optimize triage and management strategies. N-terminal pro–B-type natriuretic peptide (NT-proBNP), a marker released in response to myocardial wall stress, has been shown to rise in AECOPD even in the absence of overt cardiac disease due to hypoxia, pulmonary hypertension, and right ventricular strain [1-4].
Objectives: To evaluate the association between NT-proBNP levels and short-term adverse clinical outcomes in patients admitted with AECOPD without overt cardiac involvement, and to determine its predictive utility for ICU admission and ventilatory support.
Methods: This cross-sectional observational study included 90 consecutive patients admitted with AECOPD between July 2024 and June 2025. Patients with known heart failure, ischemic heart disease, significant valvular heart disease, cardiomyopathy, severe renal dysfunction, or echocardiographic evidence of cardiac dysfunction were excluded. NT-proBNP levels were measured at admission along with arterial blood gas (ABG) parameters and inflammatory markers. Outcomes assessed included ICU admission, need for ventilatory support, duration of ICU stay, and total hospital stay. Statistical analysis included Chi-square test, Mann–Whitney U test, Spearman correlation analysis, and receiver operating characteristic (ROC) curve analysis.
Results: The mean age of the study population was 65 years, with males comprising 69% of participants. ICU admission was required in 50% of patients, while 47.8% required ventilatory support. Median NT-proBNP level was 306.5 pg/mL. Higher NT-proBNP levels were significantly associated with ICU admission, ventilatory support, prolonged ICU stay, and longer hospital stay (p < 0.0001). NT-proBNP also showed significant correlations with worsening ABG parameters, including lower pH, higher PaCO₂, and lower PaO₂. ROC analysis demonstrated strong predictive performance, with an AUC of 0.87 for ICU admission at a cutoff of 452 pg/mL and an AUC of 0.84 for ventilatory support at a cutoff of 274 pg/mL.
Conclusion: NT-proBNP is a strong independent predictor of short-term adverse outcomes in AECOPD patients even in the absence of overt cardiac disease. Elevated NT-proBNP levels reflect physiological severity and may serve as a valuable biomarker for early risk stratification, clinical decision-making, and resource allocation in patients presenting with AECOPD.
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