NT-proBNP in Different Patient Groups of COPD: A Systematic Review and Meta-Analysis

Abstract

Purpose

NT-proBNP, a peptide biomarker synthesized and secreted by cardiomyocytes in response to cardiac load, has gained attention in recent years for its potential role in respiratory diseases. Chronic Obstructive Pulmonary Disease (COPD), a chronic and progressive inflammatory condition affecting the respiratory system, is frequently associated with comorbidities involving the cardiovascular system. Consequently, the aim of this systematic review and meta-analysis was to evaluate the variations in NT-proBNP levels across distinct patient groups with COPD and establish a foundation for future investigations into the precise clinical significance of NT-proBNP in COPD.

Methods

The search databases for this study were conducted in PubMed, Excerpt Medica database (Embase), Web of Science (WOS), and Cochrane Library databases. Databases were searched for studies on the predictive value of NT-proBNP in adult COPD patients.

Results

A total of 29 studies (8534 participants) were included. Patients with stable COPD exhibit elevated levels of NT-proBNP [standardized mean difference(SMD) [95CI%]=0.51 [0.13,0.89]; p=0.0092]. COPD patients with predicted forced expiratory volume in 1 s (FEV₁) < 50% exhibit significantly elevated levels of NT-proBNP compared to those with FEV₁ ⩾50%[SMD [95CI%]=0.17 [0.05,0.29]; p=0.0058]. NT-proBNP levels were significantly higher in acute exacerbations (AECOPD) compared to patients with stable COPD [SMD [95CI%]=1.18 [0.07,2.29]; p=0.037]. NT-proBNP levels was significantly higher in non-survivors than in survivors of hospitalised AECOPD patients [SMD [95CI%]=1.67 [0.47,2.88]; p=0.0063]. Both COPD patients with pulmonary hypertension(PH) [SMD [95CI%]=0.82 [0.69,0.96]; p<0.0001] and chronic heart failure(CHF) [SMD [95CI%]=1.49 [0.96,2.01]; p<0.0001] showed higher NT-proBNP level.

Conclusion

NT-proBNP, a biomarker commonly used in clinical practice to evaluate cardiovascular disease, demonstrates significant variations in different stages of COPD and during the progression of the disease. The fluctuations in NT-proBNP levels could be indicative of the severity of pulmonary hypoxia and inflammation and cardiovascular stress among COPD patients. Therefore, assessing NT-proBNP levels in COPD patients can aid in making informed clinical decisions.

Keywords:

• amino-terminal pro-brain natriuretic peptide
• chronic obstructive pulmonary disease
• acute exacerbation of chronic obstructive pulmonary disease
• chronic heart failure
• meta-analysis

Abbreviation

COPD, chronic obstructive pulmonary disease; BNP, brain natriuretic peptide; NT-proBNP, amino-terminal pro-brain natriuretic peptide; SCOPD, stable chronic obstructive pulmonary disease; AECOPD, acute exacerbations of chronic obstructive pulmonary disease; pg/mL, picograms per milliliter; FEV₁, forced expiratory volume in the first second; FEV₁%pred, the forced expiratory volume in the first second in percent predicted values; PRISMA, Preferred Reporting Items for Systematic Review and Meta-analyses; CI, confidence interval; SD, standard difference; SMD, standardized mean difference; CHF, chronic heart failure; PH, pulmonary hypertension; IL-1β, interleukin-1β; IL-6, interleukin-6; CRP, c-reactive protein; TNF-α, tumor necrosis factor-α.

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Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

All authors promise that there is no conflict of interests in this work.

Additional information

Funding

This work was supported by the Science and Technology Projects of Gansu Province (grant number 20YF8FA082). Funder had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript.