From China’s Multicenter Prospective Cohort: Right Ventricular Afterload and Prognosis in Hospitalized Patients with Acute Exacerbation of COPD

Aili Gao,1– 3 Xia Liu,4 Xiaojing Jiao,1,2 Yuan Ding,1,2 Zehan Gao,1,2 Yuan Gao,1,2 Junwei Zhang,1,2 Junwei Yang,1,2 Suqiao Yang,1,2,5 Yuanhua Yang1,2 1Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China; 2Beijing Key Laboratory of Multimodal Intelligent Diagnosis and Treatment System for Respiratory Diseases, Beijing, 100020, People’s Republic of China; 3Department of Respiratory and Critical Care Medicine, Beijing Shunyi District Hospital, Beijing, 101300, People’s Republic of China; 4Department of Respiratory and Critical Care Medicine, Capital Medical University Daxing Teaching Hospital, Capital Medical University, Beijing, 102600, People’s Republic of China; 5Evidence-based Medicine Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of ChinaCorrespondence: Suqiao Yang, Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China, Email [email protected] Yuanhua Yang, Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China, Tel +86-10-85231437, Fax +86-10-65005099, Email [email protected]: The relationship between increased right ventricular (RV) afterload (moderate-to-high suspicion of pulmonary hypertension indicated by echocardiography) and the prognosis of patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is not yet well understood.Patients and Methods: This prospective cohort study was conducted in 11 hospitals from 2017 to 2020, involving patients hospitalized with AECOPD. Echocardiography was performed within 48 hours of admission. Patients were classified into two groups: those with increased RV afterload (n=237) and those with normal RV afterload (n=415). Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox regression analysis to evaluate the impact of RV afterload on patient outcomes. Kaplan-Meier survival curves were employed to assess the association between RV afterload and 3-year all-cause mortality.Results: Kaplan-Meier survival curves demonstrated that the 3-year all-cause mortality rates were 22.8% in AECOPD patients with increased RV afterload and 9.5% in those with normal RV afterload. Cox regression analysis indicated that increased RV afterload is an independent predictor of poor prognosis in hospitalized AECOPD patients, significantly increasing the risk of 3-year all-cause mortality (HR=2.172, 95% CI: 1.384– 3.411; P< 0.001). Additionally, elevated brain natriuretic peptide (BNP) or n-terminal pro-brain natriuretic peptide (NT-proBNP) (HR=2.694, 95% CI: 1.724– 4.209; P< 0.001), and lower body mass index (BMI) (HR=0.880, 95% CI: 0.833– 0.930; P< 0.001) were independent risk factors for mortality.Conclusion: Increased RV afterload is associated with a significant increase in the risk of 3-year all-cause mortality in patients hospitalized with AECOPD, posing a 2.2-fold higher risk compared to those with normal RV afterload. It also stands as an independent risk factor for mortality. Elevated BNP or NT-proBNP levels and reduced BMI are additional independent risk factors of mortality. Early detection of these three risk factors could play a role in stratifying high-risk patients, guiding clinical decision-making, and improving patient outcomes in AECOPD.Plain Language Summary: In this study, we focused on individuals hospitalized for AECOPD. We investigated the association between moderate-to-high suspicion of pulmonary hypertension on echocardiography and their prognosis. Our results can help identify those at high risk of mortality. Echocardiography is a noninvasive and widely available tool, yet its validation in large real-world cohorts remains limited. Moreover, many people are hospitalized for AECOPD, and our findings apply to the much larger population seen in primary care and routine clinical practice.Keywords: respiratory diseases, echocardiography, mortality, n-terminal pro-brain natriuretic peptide/brain natriuretic peptide, body mass index