Plasma amino-terminal pro B-type natriuretic peptide as a predictor of late cardiovascular mortality in patients with acute lung disorders: a prospective, observational cohort study

Aims Pneumonia and acute exacerbations of obstructive lung diseases (AEOLD) are associated with a significant long-term mortality. Elevated level of amino-terminal pro B-type natriuretic peptide (NT-proBNP) is a predictor of late all-cause mortality in these disorders but the pathophysiological basis for this is unknown. The present study was conducted to define the predictive role of NT-proBNP on late cardiovascular mortality among patients with acute lung disorders. Methods and results This prospective, observational cohort study included 269 hospitalized patients with pneumonia or AEOLD. Plasma level of NT-proBNP, age, sex, body mass index, arterial blood oxygen saturation, C-reactive protein, and urea were recorded. The survival and causes of death were recorded after a median of six years. NT-proBNP > 666 ng/mL was related to cardiovascular mortality with an adjusted hazard ratio of 2.93 (1.19–7.18). This risk was of similar magnitude to that associated with diabetes and greater than that associated with arterial hypertension, hypercholesterolemia, and smoking. NT-proBNP was also related to all-cause mortality with adjusted hazard ratio of 2.39 (1.49–3.85) per 10 times increase in NT-proBNP concentration. However, the association between NT-proBNP and non-cardiovascular mortality did not reach statistical significance [adjusted hazard ratio 1.89 (0.93–3.85)]. Conclusion NT-proBNP concentration during pneumonia or AEOLD was strongly associated with late cardiovascular mortality but not with non-cardiovascular mortality. The results suggest that the increase in NT-proBNP during acute lung disorders may reveal occult cardiac diseases arousing a question whether patients with acute pulmonary disorders with elevated NT-proBNP levels should be subjected to further diagnostic or therapeutic cardiovascular interventions.