DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20172467

Cardiac troponin I as mortality predictor in acute exacerbation of chronic obstructive pulmonary disease

Seema Gupta, Varinder Saini, Jasbinder Kaur, Shivani Jaswal, Harjeet Kaur, Sumeet Kaur

Abstract


Background: Comorbidities are important determinants of outcome and quality of life of patients with chronic obstructive pulmonary disease (COPD). The risk of cardiovascular events in COPD patients is three to five-fold high. COPD is often associated with right ventricular hypertrophy and pulmonary hypertension. Various studies have associated levels of cardiac troponin I (cTnI) with severity and duration of acute exacerbation of COPD (AECOPD). The objective of the present study was to assess the usefulness of serum cTnI as mortality predictor in AECOPD patients.

Methods: An observational, prospective and non interventional study was conducted in 50 patients with AECOPD admitted in the pulmonary medicine emergency or ward of a tertiary care hospital of Northern India. AECOPD was diagnosed according to Global Initiative for chronic obstructive lung disease guidelines. cTnI levels were estimated within 24 hours of admission by method based on chemiluminiscence along with routine investigations. Levels ≥ 0.01ng/ml were taken as positive. The patients were followed up for 30days for outcome in terms of mortality and morbidity. Data was entered and analyzed by SPSS package and two sided p values<0.05 were considered statistically significant.

Results: The serum cTnI was found to be positive in 34% of patients with AECOPD. The in- hospital mortality was significantly low in patients having cTnI <0.01ng/ml as compared to patients with cTnI ≥0.01ng/ml. The patients with cTnI levels ≥0.01ng/ml had significantly higher mean PaCO2 levels and higher requirement for invasive or noninvasive ventilation during hospital stay as compared to patients having cTnI <0.01ng/ml (p=0.04 and 0.016 respectively).

Conclusions: Levels of cTnI≥0.01ng/ml may be considered as a biomarker to predict mortality in AECOPD patients.


Keywords


AECOPD, cTnI, Mortality, Outcome

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References


Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of disease study. Lancet. 1997;349:1347-52.

Nici L, Zuwallack R. Chronic obstructive pulmonary disease comorbidities and systemic consequences. USA: Human Press; 2012.

Anthonisen NR, Conette JE, Kiley JP, Altose MD, Bailey WC, Buist AS, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1: the Lung Health Study. JAMA. 1994;272:1497-505.

Hasaneen N, Elrahman AA, Mahdy ME, Shaer OE, Hassan M, El-Habashy MM. Evaluation of serum troponin I in patients with acute exacerbations of chronic obstructive pulmonary disease. Egyptian J Bronchiol. 2015;9:14-9.

Mahajan N, Mehta Y, Rose M, Shani J, Lichstein E. Elevated troponin is not synonymous with myocardial infarction. Int J Cardiol. 2006;111:442-9.

Noble JS, Reid AM, Jordan LV, Glen AC, Davidson JA. Troponin I and myocardial injury in the ICU. Br J Anaesth. 1999;82:41-6.

Stacy Poe, Robin HVP, Clay M, Wong HR, Haynes E, Florence GR. Cardiac troponin measurement in critically ill: potential for guiding clinical management. J Investig Med. 2015;63(8):905-15.

The 2011 revision of the global strategy for the diagnosis, management and prevention of COPD (GOLD). Available at: http:// www.goldcopd.org/ uploads/users/files/GOLD Report 2011 Feb21.pdf 2011:1-90.

Youssef AR, Hassan ASA, Ghamry RE, Ahmed AE. Serum Troponin I as a prognostic marker in acute exacerbated chronic obstructive pulmonary disease patients. Egyptian J Chest Dis Tubercul. 2013;62:549-55.

Perez-Calvo JI, Sanchez-Marteles M, Ruiz-Ruiz FJ, Morales-Rull JL, Nieto-Rodriguez JA. Differential prognostic utility of NTproBNP and cystatin C in patients with acute exacerbation of chronic pulmonary disease. J R Soc Med Sh Rep. 2010;44:1-9.

Sin DD, Anthonisen NR, Soriano JB, Agusti AG. Mortality in COPD: Role of comorbidities. Eur Respir J. 2006;28:1245-57.

Arshed S, Luo HX, Zafar S, Regeti K, Malik N, Alam M, et al. Elevated troponin I in the absence of coronaty artery disease: A case report with review of literature. J Clin Med Res. 2015;7(10):820-4.

Baillard C, Boussarsar M, Fosse JP, Girou E, Le Toumelin P, Cracco C, et al. Cardiac troponin I in patients with severe exacerbation of chronic obstructive pulmonary disease. Intens Care Med. 2003;29:584-9.

Harvey MG, Hancox RJ. Elevation of cardiac troponin in exacerbation of COPD. Emerg Med Australas. 2004;16(3):212-5.

Noorain S. Prognostic value of cardiac troponin I during acute exacerbation of chronic obstructive pulmonary disease: A prospective study. Lung India 2016;33(1):53-7.

Chang CL, Robinson SC, Mills GD, Sullivan GD, Karalus NC, McLachlan JD, et al. Biochemical markers of cardiac dysfunction predict mortality in acute exacerbations of COPD. Thorax. 2011;66:764-8.

Aksay E, Yanturali S, Kiyan S. Can elevated troponin I levels predict complicated clinical course and in hospital mortality in patients with acute pulmonary embolism? Am J Emerg Med. 2007;25:138-43.

Martins CS, Rodrigues MJO, Miranda VP, Nunes JPL. Prognostic value of cardiac troponin I in patients with COPD acute exacerbation. Netherlands J Med. 2009;67(10):341-49.