Plasma levels of atrial natriuretic peptide and brain natriuretic peptide following intravenous saline infusion in oedematous chronic obstructive pulmonary disease and non-oedematous chronic obstructive pulmonary disease

Midregional proatrial natriuretic peptide predicts survival in exacerbations of COPD

BACKGROUND

Recently, the use of systemic biomarkers to monitor and assess the clinical evolution of respiratory disease has gained interest. We investigated whether midregional proatrial natriuretic peptide (MR-proANP) predicts survival in patients with COPD when they are admitted to the hospital for exacerbation.

METHODS

One hundred sixty-seven patients (mean age 70 years old, 75 men) admitted to the hospital for exacerbation were followed up for 2 years. MR-proANP was measured on admission, after 14 days, and at 6 months. The predictive value of clinical, functional, and laboratory parameters on admission were assessed by Cox regression analyses. The time to death was analyzed by Kaplan-Meier survival curves.

RESULTS

MR-proANP level was significantly higher on admission for exacerbation, compared with recovery and stable state (P = .004 for the comparison among all time points). MR-proANP correlated with the Charlson condition and age-related score (P < .0001), left ventricular ejection fraction (P < .0001), C-reactive protein (P = .037), and FEV(1)% predicted (P = .004). MR-proANP levels were similar in patients requiring ICU treatment and in those treated in the medical ward (P = .086). Thirty-seven patients (22%) died within 2 years. MR-proANP levels were higher in nonsurvivors compared with survivors (median [interquartile range] 185 pmol/L [110-286] vs 92 pmol/L [56-158], P < .001). Mortality was higher across MR-proANP quartiles (log rank P < .0001). Charlson condition and age-related score (P = .001), Paco(2) (P < .0001), and MR-proANP (P = .001) predicted mortality in the univariate Cox-regression model. Both MR-proANP and Paco(2) were independent predictors of mortality in the multivariate Cox regression model.

CONCLUSIONS

MR-proANP at exacerbation is associated with 2-year long-term survival in patients with exacerbation of COPD.

Should plasma be transfused prophylactically before invasive procedures?

PURPOSE OF REVIEW

Plasma transfusion to correct abnormal coagulation test results prior to an invasive procedure is a common clinical practice; however, there are no evidence-based guidelines. This review aims to analyze the most recent publications to either support or disprove such practice.

RECENT FINDINGS

Due to heightened awareness of transfusion-related acute lung injury and volume overload in susceptible patients, clinicians are increasingly questioning the validity of prophylactic plasma transfusion. Recently, several articles, reviews and clinical studies (although small and poorly designed) have shown no benefit of prophylactic plasma transfusion in either correcting abnormal coagulation tests or reducing perceived risk of hemorrhage.

SUMMARY

The use of sensitive reagents (especially for prothrombin time) has resulted in increased incidence of abnormal preprocedure coagulation screening test results - tests that are not designed to assess risk of bleeding in patients without a history of bleeding. Transfusion of plasma prior to an invasive procedure to correct mild to moderate abnormal test results neither corrects the abnormality nor reduces the perceived bleeding risk.

Renal hyporesponsiveness to brain natriuretic peptide: both generation and renal activity of cGMP are decreased in patients with pulmonary hypertension

We examined the mechanisms of renal resistance to atrial and brain natriuretic peptides (ANP and BNP) in pulmonary hypertension (PH). Compared to eight controls, nine PH patients showed a reduced ability to excrete an acute sodium load despite increased circulating ANP, BNP and cyclic guanosine monophosphate (cGMP), their second messenger. Patients' reduced urinary cGMP/BNP and natriuresis/urinary cGMP ratios demonstrated impaired generation of and reduced renal response to cGMP, respectively. Therefore, PH patients hyporesponsiveness to cardiac natriuretic peptides is likely located both upstream and downstream cGMP generation. Natriuretic peptide signalling pathway disruptions might be accessible to therapy.