Midregional pro atrial naturetic peptide (MRproANP) and copeptin (COPAVP) as predictors of all- cause mortality in early COPD – Results from COSYCONET

Abstract

Abstract Background: A number of prognostic markers of mortality are known in chronic obstructive pulmonary disease (COPD) but less so for early and mild stages of the disease. We thus analyzed several biomarkers as potential predictors of mortality in early COPD. Methods: The blood biomarkers considered were copeptin (COPAVP), midregional adrenomedullin (MRproADM), midregional pro atrial naturetic peptide (MRproANP), and fibrinogen. Analyses were performed in patients with stable “early COPD” defined by GOLD grades 0-2 and diagnosis of COPD ≤5 years prior to inclusion into the COSYCONET cohort (COPD and Systemic Consequences - Comorbidities Network), using Cox regression analysis with stepwise adjustment for multiple COPD characteristics, comorbidities, troponin and NT-proBNP. Results: 655 patients with early COPD were included. In the initial regression model, 43 of 655 patients died during the 6-year follow-up, in the final model 27 of 487. Regression analyses with adjustment for confounders identified COPAVP and MRproANP as statistically robust biomarkers (p<0.05 each) of all-cause mortality, while MRproADM and fibrinogen were not. The fourth quartile of MRproANP (97 pmol/L) was associated with a hazard ratio of 4.5 (95%CI: 1.6; 12.8), and the fourth quartile of COPAVP (9.2 pmol/L) with 3.0 (1.1; 8.0). The results for MRproANP were confirmed in the total cohort of grade 0-4 (n=1470 finally). Conclusion: In patients with early COPD, elevated values of COPVP and in particular MRproANP were robust, independent biomarkers for all-cause mortality risk after adjustment for multiple other factors. This suggests that these markers might be considered in the risk assessment of early COPD.