PROGNOSTIC VALUE OF CARDIAC TROPONINI IN ACUTE EXACERBATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Dr. Ahraz Ali Imam, Dr. M. P. Singh

Abstract


Background: Chronic obstructive pulmonary disease (COPD) is a major cause of mortality and morbidity. It is the fourth
leading cause of death worldwide. Acute exacerbations of COPD are common and are associated with worsening lung
function and mortality. Objectives: To evaluate the prevalence of elevation of cTnI in patients admitted with acute
exacerbation of COPD and to study its association with the need for ventilator support, duration of hospital stay, and inhospital
mortality. In a prospective design, 50 patients admitted to our hospital with acute exacerbation Methods: xacerbation of
COPD were included. cTnI was assayed in a blood sample obtained at admission and 24 h later. Levels above 0.017 μg/L
were taken as positive. The following data were also recorded–demographic data, pattern of tobacco use, clinical
symptoms and signs, comorbidities, Glasgow Coma Scale, arterial blood gas, electrocardiogram/two-dimensional
echocardiography, chest X-ray, and peak expiratory flow rate. Results: Among the 50 patients, 4 were females, and 46
were males. cTnI was positive in 32% of patients with a mean value of 0.272. Patients with cTnI positive were taken as
Group I and those with negative were included in Group II. Prevalence of comorbidities was higher in cTnI positive
group, so was the duration of COPD. cTnI elevation correlated significantly with the need for ICU admission and
ventilator support. No significant difference was found in the duration of ventilator support, hospital stay, and in-hospital
mortality. Conclusion: cTnI is elevated in a significant subset of patients with acute exacerbation of COPD. Duration of
their illness was longer, higher incidence of ischemic heart disease was also found in these patients. Patients with cTnI
elevation are more likely to require ICU care and ventilator support. However, it did not predict in-hospital mortality.
Thus, it can be used as a marker to identify high-risk patients during acute exacerbation of COPD.


Full Text:

PDF

References


GOLD. Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease. Updated 2019 Available from: http://www.goldcopd.org .

WHO. World Health Statistics. 2008.Available from: http://www.who.int/whosis/whostat/EN_WHS08_Full.pdf .

Nici L, ZuWallack R. USA: Humana Press; 2012. Chronic Obstructive Pulmonary Disease Co-morbidities and Systemic Consequences.

Evensen AE. Management of COPD exacerbations. Am Fam Physician. 2010;81:607–13.

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

Han MK, McLaughlin VV, Criner GJ, Martinez FJ. Pulmonary diseases and the heart. Circulation. 2007;116:2992–3005.

Malerba M, Romanelli G. Early cardiovascular involvement in chronic obstructive pulmonary disease. Monaldi Arch Chest Dis. 2009;71:59–65.

Macnee W, Maclay J, McAllister D. Cardiovascular injury and repair in chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2008;5:824–33.

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. Intensive Care Med. 2003;29:584–9.

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.

Martins CS, Rodrigues MJ, Miranda VP, Nunes JP. Prognostic value of cardiac troponin I in patients with COPD acute exacerbation. Neth J Med. 2009;67:341–9.

Høiseth AD, Neukamm A, Karlsson BD, Omland T, Brekke PH, Søyseth V. Elevated high-sensitivity cardiac troponin T is associated with increased mortality after acute exacerbation of chronic obstructive pulmonary disease. Thorax. 2011;66:775–81.

Brekke PH, Omland T, Holmedal SH, Smith P, Søyseth V. Determinants of cardiac troponin T elevation in COPD exacerbation – A cross-sectional study. BMC Pulm Med. 2009;9:35.


Refbacks

  • There are currently no refbacks.