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Novel biomarkers for prediction of mortality after acute exacerbation of chronic obstructive pulmonary disease

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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Correspondence to H Michalopoulou.

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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, P134 (2013). https://doi.org/10.1186/cc12072

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Keywords

  • Chronic Obstructive Pulmonary Disease
  • Acute Coronary Syndrome
  • Acute Exacerbation
  • Pulmonary Artery Pressure
  • Cardiac Troponin