| BackgroundChronic obstructive pulmonary disease(COPD) is the fourth leading cause of death in the world,and left heart failure(LHF) is one of its common complications. COPD and left heart failure not only have some shared risk factors, such as smoking, advanced age and systemic inflammation, but also have similar clinic performance, such as dyspnea, especially in acute exacerbation, the dyspnea perform of patients with COPD will be deteriorated, and there will be a question perplexing the clinical doctors that which cause deterioration of dyspnea, simple acute exacerbation of chronic obstructive pulmonary disease( AECOPD), or complication with left heart failure? so left heart failure can not be recognized in time in part of patients with AECOPD complicated with acute left heart failure. N-terminal pro-brain natriuretic peptide(NT-pro BNP) is sensitive biomaker of left heart failure, and it is used for distinguishing cardiac dyspnea from non-cardiac dyspnea, and some literatues and guidelines have recommended cut-off value about it. However, the following study indicates that NTpro BNP elevates not only in left heart failure, but also in AECOPD. How severe the plasma NT-pro BNP of AECOPD is we should consider the patient is complicated with left heart failture? With respect to the NT-pro BNP for differential diagnosis of dyspnea, most study and guidelines at home and abroad will compare cardiac dyspnea patients with pulmonary dyspnea patients( for example: AECOPD), but the case that compare AECOPD complicated with LHF with simple AECOPD is rare. So far the cut-off value in guideline of left heart failure is fit for differential diagnosis of dyspnea in AECOPD patients? About the matter of cut-off value of AECOPD complicated with left heart failure, Abroug?Wang and other scholars carry out some related study, but the cut-off value that they work out are not unanimous. The reason may be related to the hypoxia, infection and severity of illness of their subjects. Abroug's subjects are the patients with AECOPD in ICU, the condition of the patients are worse relatively, and Wang's subjects are patients with acute exacerbation of chronic bronchitis,including AECOPD partly. Therefore, in this study, we take AECOPD in respiratory department as major subject, discuss the variation of NT-pro BNP and impact factors in patients with acute left heart failure?AECOPD and AECOPD complicated with left heart failure, and try to work out the diagnostic cut-off and exclusive cut-off of NTpro BNP in patients with AECOPD complicated with left heart failure to achieve the goal of rapid and accurate differential diagnosis. ObjectiveDiscuss the variation of NT-pro BNP and impact factors in patients with acute left heart failure?AECOPD and AECOPD complicated with left heart failure, and try to work out the diagnostic cut-off and exclusive cut-off of NT-pro BNP in patients with AECOPD complicated with left heart failure to achieve the goal of rapid and accurate differential diagnosis. Subjects and MethodsThis is a randomized controlled clinical study. In this study, we collect 120 patients with AECOPD, complete blood gas analysis?blood routine examination?serum creatinine?procalcitonin?hypersensitive C-reactive protein?echocardiography and so on,and collect plasma samples to measure plasma NT-pro BNP. Based on the outcome of echocardiography, we devide the subjects into two groups: AECOPD complicated with left heart failure group(A group) and simple AECOPD group(B group). Judge whether plasma NT-pro BNP is the risk factor of left heart failure by Logistic regression, discuss the related factors of elevated plasma NT-pro BNP in AECOPD by multivariate liner regression analysis, analyse the diagnostic value of NT-pro BNP for AECOPD complicated with left heart failure by area under the curve(AUC) of receiver operating characteristic(ROC), and work out diagnostic cut-off and exclusive cut-off. Results1?General information: there are 120 AECOPD patients collecting in this study, including 27(male: 18, female: 9) in A group, mean age is 77.9±7.5; 93(male: 73, female: 20) in B group, mean age is 73.7±8.5. There is no statistical difference in the percentage of gander and age between them. Plasma NT-pro BNP in A group is 5488±4768 pg/ml, 348±738 pg/ml in B group. There is statistical difference in plasma NT-pro BNP between the two groups.2?The risk factor analysis of left heart failture: LVEF is protective factor, the value of OR is 0.853,P=0.006,95% confidence interval: 0.762-0.955;NT-pro BNP is risk factor,OR: 1.002,P=0.001,95% confidence interval: 1.001-1.003. If we set the value of interval as 100, and OR' is 1.22, and it means that the risk for left heart failure will increase by 22% when the value of plasma NT-pro BNP increase by 100 pg/ml.3?Correlation analysis of plasma NT-pro BNP: in univariate analysis,there is statistical difference in PH?PO2?PCO2?SO2?PCT?CRP?HGB?LVEF?PAP. In multivariate linear regression analysis, plasma NT-pro BNP is positively associated with PCT(?=0.302,P=0.000)?PAP(?=0.212,P=0.007), negatively associated with LVEF(?=-0.332,P=0.000)? HGB(?=-0.211,P=0.006).4?The diagnostic value of NT-pro BNP for AECOPD complicated with left heart failture: the area under the curve of receiver operating characteristic(ROC) of NT-pro BNP is 0.943(95% confidence interval: 0.897-0.989,P=0.000). When NT-pro BNP is 1618 pg/ml,the sensitivity is 81.5%, specificity is 96.8%, it can be the diagnostic cut- off. When NTpro BNP is 794.6pg/ml,the sensitivity will elevate to 85.2%,specificity is 90.3%, it can be exclusive cut-off. Conclusions1?Besides left heart dysfunction, procalcitonin?anemia? pulmonary hypertension may be the reason for the elevated NT-pro BNP in AECOPD patients.2?NT-pro BNP can help to diagnose whether AECPOD patients are complicated with left heart failure, the diagnostic cut-off value is 1618 pg/ml, and the exclusive cut-off value is 794.6pg/ml. |
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