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| The value of blood markers and echocardiography in the evaluation of COPD-related pulmonary hypertension |
| Sun Yun, Lu Shi-qi, Tu Su, You Chun-yuan, Wang Yang, Gong Yan-lin |
| Department of Emergency, The Affiliated Wuxi No. 2 People′s Hospital of Nanjing Medical University, Wuxi 214002, China |
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Abstract Objective This article aimed at early diagnosis and assessment of chronic obstructive pulmonary disease(COPD)with pulmonary hypertension. Methods A total of 66 inpatients diagnosed with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) were enrolled in the Affiliated Wuxi No.2 People′s Hospital of Nanjing Medical University from October 2016 to February 2018. The patient′s general conditions were recorded and blood tests were performed. Echocardiography was performed to measure right heart parameters. The relationship between these indexes and pulmonary artery pressure was analyzed.The pulmonary arterial systolic pressure (PASP) was measured by echocardiography, and PASP≥36 mm Hg as the standard of pulmonary hypertension. Patients were divided into two groups according to whether there was pulmonary hypertension or not. The clinical data were compared between normal pulmonary arterial pressure group (N group)and pulmonary hypertension group (PH group). Logistic regression analysis was performed to investigate the risk factors of COPD-related pulmonary hypertension. Receiver operating characteristic curve (ROC curve) was used to compare the effect of each risk factor alone or in combination on the prediction of pulmonary hypertension. Results There was no significant differences in age, gender, body mass index, course of disease, smoking index between the two groups (P>0.05). In group N and group P, the results of red blood cell distribution width (RDW), neutrophil/lymphocyte ratio (NLR), N-terminal pro-brain natriuretic peptide (NT-proBNP), carbohydrate-associated antigen 125(CA125),and right myocardial performance index (RMPI)were as follows:13.16±0.91persent,13.99±2.01persent; 4.01(2.33,6.10),5.55(3.95,8.55);143.80(82.38,284.00)pg/mL,834.00(359.05,1825.00)pg/mL; 11.80(6.79,20.15) U/mL,18.53(12.30,46.05) U/mL; 0.37±0.08,0.51±0.13.There were significant differences between the two groups in RDW, NLR, NT-proBNP, CA125 and RMPI(P<0.05). There were no significant differences in other blood parameters and right heart parameters between the two groups (P>0.05). Gender, age, RDW, NLR, NT-proBNP, CA125 and RMPI were selected as independent variables, and whether there was pulmonary hypertension or not was used as the dependent variable. Logistic regression analysis was performed.Results showed that RMPI (OR=1.004，95%CI 1.001-1.007) and NT-proBNP (OR=1.181,95%CI 1.068-1.305) were found being independent risk factors for pulmonary hypertension in patients with COPD. The ROC curve analysis showed that the threshold value of NT-proBNP for determining pulmonary hypertension was 391.75 pg/ml, the area under the ROC curve (AUC) was 0.809,with sensitivity and specificity of 0.759 and 0.838, respectively. The cutoff value of RMPI for judging pulmonary hypertension was 0.485,AUC was 0.797,and the sensitivity and specificity were 0.621 and 0.919, respectively.AUC of NT-proBNP combined with RMPI was 0.932,and the sensitivity and specificity were 0.793 and 0.919, respectively. By comparing with AUC of NT-proBNP and RMPI, there were no significant differences for predicting pulmonary hypertension (Z=0.151, P>0.05).NT-proBNP combined with RMPI did have discriminating power for predicting pulmonary hypertension compared with AUC of NT-proBNP(Z=2.449, P<0.05) and RMPI (Z=2.928, P<0.05).The results showed that NT-proBNP combined with RMPI was superior to NT-proBNP and RMPI in predicting pulmonary hypertension. Conclusion Increases in RDW, NLR, NT-proBNP, and CA125 may indicate pulmonary hypertension. Echocardiography is an important noninvasive assessment method for pulmonary arterial pressure in patients with COPD-associated pulmonary hypertension. RMPI and NT-proBNP are sensitive in diagnosing pulmonary hypertension and can be used to evaluate right heart function in combination with other right heart parameters. NT-proBNP combined with RMPI can increase predicting capability of AECOPD-associated pulmonary hypertension.
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Corresponding Authors:
Lu Shi-qi, E-mail: lushiqi2004@126.com
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