Prognostic and diagnostic significance of mid-regional pro-atrial natriuretic peptide in acute exacerbation of chronic obstructive pulmonary disease and acute heart failure: data from the ACE 2 Study

Abstract

Purpose: To compare the diagnostic and prognostic value of mid-regional pro-ANP (MR-proANP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with acute dyspnea.

Methods: MR-proANP and NT-proBNP were measured with commercial immunoassays at hospital admission (n = 313), on day 2 (n = 234), and before discharge (n = 91) and compared for diagnosing acute heart failure (HF; n = 143) and to predict mortality among patients with acute HF and acute exacerbation of chronic obstructive pulmonary disease (AECOPD; n = 84) separately.

Results: The correlation coefficient between MR-proANP and NT-proBNP was 0.89 (p < 0.001) and the receiver-operating area under the curve (AUC) was 0.85 (95% CI 0.81–0.89) for MR-proANP and 0.86 (0.82–0.90) for NT-proBNP to diagnose acute HF. During a median follow-up of 816 days, mortality rates were 46% in acute HF patients and 42% in AECOPD patients. After adjustment for other risk variables by multivariate Cox regression analysis, MR-proANP and NT-proBNP concentrations were associated with mortality in patients with acute HF, but only MR-proANP were associated with mortality among patients with AECOPD: hazard ratio (_lnMR-proANP) 1.98 (95% CI 1.17–3.34).

Conclusion: MR-proANP and NT-proBNP concentrations provide similar diagnostic and prognostic information in patients with acute HF. In contrast to NT-proBNP, MR-proANP measurements also provided independent prognostic information in AECOPD patients.

KEYWORDS:

• MR-proANP
• NT-proBNP
• biomarker
• COPD
• heart failure
• prognosis

Acknowledgments

We would like to acknowledge the contribution by the Clinical Trial Unit, Division of Medicine, Akershus University Hospital, for patient inclusion and especially thank Vigdis Bakkelund, RN; Annika Lorentzen, RN; and Marit Holmefjord Pedersen, BSc. We also acknowledge Multidiciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital for biomarker analyses.

Disclosure statement

Thermo Fisher Scientific, Clinical Diagnostics, BRAHMS GmbH, 16761 Hennigsdorf, Germany, Tel: [phone] provided MR-proANP reagents free of charge for this study. NT-proBNP kits were supplied at reduced price by Roche Diagnostics.

No potential conflict of interest was reported by the authors.

Additional information

Funding

The ACE 2 Study was funded by a research grant from the Norwegian Research Council to TO and HR and by internal grants from Akershus University Hospital.