Role of Natriuretic Terminal Pro B-type Natriuretic Peptide (NT-Pro-BNP) in Diagnosis of Heart Failure in Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD), Retrospective Cohort Study Conducted in Karachi, Pakistan

Abstract

Introduction: COPD and heart failure effecting millions of people in the world where as combinedly becomes deadlier and affecting the major population of different regions of world, also increasing the rate of morbidity and mortality. Diagnosis of heart failure in COPD patients or COPD in heart failure patient is very difficult for cardiologist and pulmonologist. Objective: Acute exacerbation of COPD concomitant with Heart failure is among the diseases responsible for increasing the Mortality, morbidity, economic burden on patients, health care system and to see the impact on gender-based incidence Early use of NT-Pro-BNP is evaluated in COPD patients for diagnosis of heart failure in Pakistan due to socio-cultural and economical differences this study was conducted. Methods: The study was conducted in 7th Day Karachi Adventist hospital from Nov 2020 to Nov 2021, retrospective cohort study in admitted patients with acute exacerbation of COPD. Qualitative variables including gender, age groups, smoking status, symptoms and clinical finding were recorded. Data was entered and analyzed in statistical package for social sciences (SPSS) version 22. Quantitative variables including age in years, duration of COPD, NT-Pro-BNP level and ejection fraction was presented in mean and standard deviation. For the determination of association between qualitative variables chi-square test was used. Results: In our study heart failure was reported in 89 (85.5%) patients of AECOPD on the basis of Pro -BNP level with Heart Failure & COPD without Heart Failure in 15 (14.4%) patients by using NT-Pro-BNP as a marker of heart Failure. independent sample was used for calculating mean difference (8042.2),95 %CI (1060.7-23.0) and P-value 0.02 *between patients of COPD with heart failure and without HF P-value shows significant difference between Pro BNP level of COPD with heart failure and without Heart failure. Gender of Patients with COPD was male in 61 (58.6%) patients and female in 43 (41.3%). Mean age of the patient with acute exacerbation of COPD was 70.0±11.2 (40-98) years. Age distribution of patients with acute exacerbation of COPD in male vs female was in age group <50 years was 4 (3.8%) vs 1 (0.9%), in age group 50-75 years was 50 (48%) vs 22 (21.1%), and in age group <75 years was 20 (19.2%) vs 7 (6.7%) shows male patients more suffering than women in all age groups. On history and clinical examination Symptoms of shortness of breathing and Coughing were more in male then female. Mean ejection fraction of patients with acute exacerbation of COPD without HF minimum E.F was 40% and maximum was 70% with mean 26%. COPD with HF minimum E.F was 20% and maximum was 70% with mean 52% ±16.6 (20-70%). Mean Pro-BNP level of patients with acute exacerbation of COPD was 7498 ±12221 (17-36000) pg/ml. Chi-square test value was 0.122 and P-value was 0.7. Conclusion: It was concluded from this study that the level of NT-Pro-BNP in patients with acute Exacerbation of COPD. diagnosed with Heart Failure was significantly high as compared to patient of acute exacerbation without Heart Failure especially high in males than females. Early diagnosis of heart failure in COPD patients will be helpful in early initiation of heart failure, medication, decreasing the hospital admissions, hospital stay and cost burden on patients and health care system of low socio-economical countries.