Introduction
Retrospective studies suggest that cardiac troponin levels are often elevated in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) indicating a poor survival. Novel high-sensitivity cardiac troponin (hs-cTnT) assays have better analytical precision than standard troponin (cTnT) assays. We elaborated a prospective cohort study to investigate the prognostic value of this novel biomarker in patients with AECOPD.
Methods
Fifty-six patients (mean age 64 years, 68% male) with the final diagnosis of AECOPD were enrolled. Those who were diagnosed with acute coronary syndromes were excluded. We measured cardiac troponin T with a standard fourth-generation assay and a high-sensitivity assay. Clinical, electrocardiographic and echocardiographic data were collected at admission and the primary prognostic endpoint was death during 30 days of follow-up.
Results
Mean hs-cTnT levels at admission were 34 ng/l. During the follow-up period seven patients (12%) died. Thirty-eight percent of patients had hs-cTnT above the range of 14 ng/l. Prognostic accuracy of hs-cTnT for death was significantly higher, with area under the ROC curve (AUC) of 0.83 (95% CI: 0.72 to 0.86), than that of cTnT (AUC: 0.63, 95% CI: 0.56 to 0.74; P < 0.001). After adjustment for age, gender, creatinine levels, heart rate, left ventricular ejection fraction, arterial O2 pressure and systolic pulmonary artery pressure, hs-cTnT above the 99th percentile was associated with a hazard ratio for death of 3.2 (95% CI: 1.5 to 6.7).
Conclusion
In AECOPD, novel biomarkers such as hs-cTnT appear to be positively associated with COPD severity and could be a determinant of mortality.
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Michalopoulou, H., Michalopoulou, H., Stamatis, P. et al. Novel biomarkers for prediction of mortality after acute exacerbation of chronic obstructive pulmonary disease. Crit Care 17 (Suppl 2), P134 (2013). https://doi.org/10.1186/cc12072
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DOI: https://doi.org/10.1186/cc12072