Serum Concentrations of Cardiac Troponin I Is Correlated With the Outcomes of Patients With Chronic Obstructive Pulmonary Disease Exacerbation Referred to Emergency Department
-
Kavous Shahsavarinia
,
Neda Moghadasian Niaki
,
Ali Taghizadieh
,
Peyman Habibi
,
Ahmad Separham
,
Neda Gilani
,
Neda Dolatkhah
Abstract
Acute exacerbations are the important reasons for hospitalization and death in chronic obstructive pulmonary disease (COPD) patients. We aimed to evaluate the relationship between serum concentrations of cardiac troponin I (cTnI) and the outcome of COPD patients visiting the emergency department with acute exacerbation of COPD (AECOPD). In this study, we included 90 AECOPD patients between October 2018 and October 2019. Serum cTnI was measured during the first 24 and 48 hours after admission. Patients were categorized into two groups positive cTnI values (≥0.3 ng/dl) and negative cTnI (<0.3 ng/dl). The outcomes of patients were compared between the two groups. Patients in Positive cTnI group in the first 24 hours and 48 hours compared to patients in negative group had significantly higher rate of in-hospital [(66.7% vs. 3.7%, P<0.001) and (50.0% vs. 3.8%, P<0.001), respectively)] and 30-day mortality rates [(88.9% vs. 3.3%, P<0.001) and (66.7% vs. 5.1%, P<0.001), respectively)]. The number of cases requiring intubation [(100% vs. 12.3%, P<0.001) and (75.0% vs. 12.8%, P<0.001), respectively)] and cardiopulmonary resuscitation (CPR) [(100.0% vs. 5.5%, P<0.05) and (100.0% vs. 5.5%, P<0.001), respectively)] as well as the duration of intensive care unit (ICU) stay [(37.00±14.61 vs 9.83±4.93 days, P<0.001) and (37.00±14.61 vs 9.83±4.93 days, P<0.001), respectively)] were also higher in cTnI positive patients. Increased cTnI during AECOPD is associated with higher rates of CPR, need for mechanical ventilation and in-hospital, short-term mortalities, and a longer ICU stay.
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2. Putcha N, Puhan MA, Hansel NN, Drummond MB, Boyd CM. Impact of comorbidities on self-rated health in self-reported COPD: an analysis of NHANES 2001-2008.COPD 2013;10:324-32.
3. Mathioudakis AG, Janssens W, Sivapalan P, Singanayagam A, Dransfield MT, Jensen J-US, et al. Acute exacerbations of chronic obstructive pulmonary disease: in search of diagnostic biomarkers and treatable traits. Thorax 2020;75:520-7.
4. Franssen FM, Alter P, Bar N, Benedikter BJ, Iurato S, Maier D, et al. Personalized medicine for patients with COPD: where are we? Int J Chron Obstruct Pulmon Dis 2019;14:1465-84.
5. Garcia-Aymerich J, Farrero E, Félez MA, Izquierdo J, Marrades RM, Antó JM. Risk factors of readmission to hospital for a COPD exacerbation: a prospective study. Thorax 2003;58:100-5.
6. Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med 2001;163:1256-76.
7. Barnes PJ. Chronic obstructive pulmonary disease. The N Engl J Med 2000;343:269-80.
8. Hole D, Watt G, Davey-Smith G, Hart C, Gillis C, Hawthorne V. Impaired lung function and mortality risk in men and women: findings from the Renfrew and Paisley prospective population study. BMJ 1996;313:711-5.
9. Vollset SE, Tverdal A, Gjessing HK. Smoking and deaths between 40 and 70 years of age in women and men. Ann Intern Med 2006;144:381-9.
10. Nilsson U, Mills NL, McAllister DA, Backman H, Stridsman C, Hedman L, et al. Cardiac biomarkers of prognostic importance in chronic obstructive pulmonary disease. Respir Res 2020;21:162.
11. Shah AS, McAllister DA, Mills R, Lee KK, Churchhouse AM, Fleming KM, et al. Sensitive troponin assay and the classification of myocardial infarction. Am J Med 2015;128:493-501.e3.
12. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al. Third universal definition of myocardial infarction. J Am Coll Cardiol 2012;60:1581-98.
13. Høiseth A, Neukamm A, Karlsson B, Omland T, Brekke P, 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.
14. Pavasini R, d'Ascenzo F, Campo G, Biscaglia S, Ferri A, Contoli M, et al. Cardiac troponin elevation predicts all-cause mortality in patients with acute exacerbation of chronic obstructive pulmonary disease: systematic review and meta-analysis. Int J Cardiol 2015;191:187-93.
15. Mannino DM, Thorn D, Swensen A, Holguin F. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur Respir J 2008;32:962-9.
16. 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 medicine. 2003;29:584-9.
17. Brekke P, Omland T, Holmedal S, Smith P, Søyseth V. Troponin T elevation and long-term mortality after chronic obstructive pulmonary disease exacerbation. Eur Respir J 2008;31:563-70.
18. Fruchter O, Yigla M. Cardiac troponin-I predicts long-term mortality in chronic obstructive pulmonary disease. COPD 2009;6:155-61.
19. Martins C, Rodrigues M, Miranda V, Nunes J. Prognostic value of cardiac troponin I in patients with COPD acute exacerbation. Neth J Med 2009;67:341-9.
20. 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.
21. Snell N, Newbold P. The clinical utility of biomarkers in asthma and COPD. Curr Opin Pharmacol 2008;8:222-35.
22. Missov E, Calzolari C, Pau B. Circulating cardiac troponin I in severe congestive heart failure. Circulation 1997;96:2953-8.
23. Meyer T, Binder L, Hruska N, Luthe H, Buchwald AB. Cardiac troponin I elevation in acute pulmonary embolism is associated with right ventricular dysfunction. J Am Coll Cardiol 2000;36:1632-6.
24. Harvey MG, Hancox RJ. Elevation of cardiac troponins in exacerbation of chronic obstructive pulmonary disease. Emerg Med Australas 2004;16:212-5.
25. Babuin L, Jaffe AS. Troponin: the biomarker of choice for the detection of cardiac injury. CMAJ 2005;173:1191-202.
26. Omland T. New features of troponin testing in different clinical settings. J Intern Med 2010;268:207-17.
27. Favory R, Neviere R. Bench-to-bedside review: significance and interpretation of elevated troponin in septic patients. Crit Care 2006;10:224.
28. Marcun R, Sustic A, Brguljan PM, Kadivec S, Farkas J, Kosnik M, et al. Cardiac biomarkers predict outcome after hospitalisation for an acute exacerbation of chronic obstructive pulmonary disease. Int J Cardiol 2012;161:156-9.
29. Youssef ARI, Hassan ASA, El-Ghamry R, Ahmed AE. Serum troponin-I as a prognostic marker in acute exacerbated chronic obstructive pulmonary disease patients. Egypt J Chest Dis Tuberc 2013;62:549-55.
30. Hasaneena N, Abd Elrahmana A, El Mahdya M, El Shaerb O, Hassanc M, El-Habashyd M. Positive cTnI in AECOPD patients may suggest exacerbation severity, the need for mechanical ventilation (MV), and longer duration of hospitalization. Egypt J Broncho. 2019;9:14-9.
31. Yıldırım F, Esquinas AM. Cardiac troponin trends and severity in chronic obstructive pulmonary disease exacerbation: Are limits properly associated for Intensive Care Unit outcome? Lung India 2016;33:583-4.
32. Gupta S, Saini V, Kaur J, Jaswal S, Kaur H, Kaur S. Cardiac troponin I as mortality predictor in acute exacerbation of chronic obstructive pulmonary disease. Int J Res Med Sci 2017;5:2669.
33. Raji H, Valipour A, Moradi M, Dastoorpoor M, Malamir MD, Ghanbaran A. The Prognostic Value of Cardiac Troponin I in Acute Exacerbation Phase of Chronic Obstructive Pulmonary Disease. Curr Respir Med Rev 2018;14:161-5.
34. Boschetto P, Beghe B, Fabbri LM, Ceconi C. Link between chronic obstructive pulmonary disease and coronary artery disease: implication for clinical practice. Respirology 2012;17:422-31.
35. Hawkins NM, Virani S, Ceconi C. Heart failure and chronic obstructive pulmonary disease: the challenges facing physicians and health services. Eur Heart J 2013;34:2795-807.
36. Campo G, Pavasini R, Malagu M, Mascetti S, Biscaglia S, Ceconi C, et al. Chronic obstructive pulmonary disease and ischemic heart disease comorbidity: overview of mechanisms and clinical management. Cardiovasc Drugs Ther 2015;29:147-57.
37. Campo G, Pavasini R, Pollina A, Tebaldi M, Ferrari R. On-treatment platelet reactivity in patients with chronic obstructive pulmonary disease undergoing percutaneous coronary intervention. Thorax 2014;69:80-1.
38. Campo G, Pavasini R, Malagù M, Punzetti S, Napoli N, Guerzoni F, et al. Relationship between troponin elevation, cardiovascular history and adverse events in patients with acute exacerbation of COPD. COPD 2015;12:560-7.
39. Høiseth AD, Omland T, Hagve TA, Brekke PH, Søyseth V. Determinants of high-sensitivity cardiac troponin T during acute exacerbation of chronic obstructive pulmonary disease: a prospective cohort study. BMC Pulm Med 2012;12:22.
2. Putcha N, Puhan MA, Hansel NN, Drummond MB, Boyd CM. Impact of comorbidities on self-rated health in self-reported COPD: an analysis of NHANES 2001-2008.COPD 2013;10:324-32.
3. Mathioudakis AG, Janssens W, Sivapalan P, Singanayagam A, Dransfield MT, Jensen J-US, et al. Acute exacerbations of chronic obstructive pulmonary disease: in search of diagnostic biomarkers and treatable traits. Thorax 2020;75:520-7.
4. Franssen FM, Alter P, Bar N, Benedikter BJ, Iurato S, Maier D, et al. Personalized medicine for patients with COPD: where are we? Int J Chron Obstruct Pulmon Dis 2019;14:1465-84.
5. Garcia-Aymerich J, Farrero E, Félez MA, Izquierdo J, Marrades RM, Antó JM. Risk factors of readmission to hospital for a COPD exacerbation: a prospective study. Thorax 2003;58:100-5.
6. Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med 2001;163:1256-76.
7. Barnes PJ. Chronic obstructive pulmonary disease. The N Engl J Med 2000;343:269-80.
8. Hole D, Watt G, Davey-Smith G, Hart C, Gillis C, Hawthorne V. Impaired lung function and mortality risk in men and women: findings from the Renfrew and Paisley prospective population study. BMJ 1996;313:711-5.
9. Vollset SE, Tverdal A, Gjessing HK. Smoking and deaths between 40 and 70 years of age in women and men. Ann Intern Med 2006;144:381-9.
10. Nilsson U, Mills NL, McAllister DA, Backman H, Stridsman C, Hedman L, et al. Cardiac biomarkers of prognostic importance in chronic obstructive pulmonary disease. Respir Res 2020;21:162.
11. Shah AS, McAllister DA, Mills R, Lee KK, Churchhouse AM, Fleming KM, et al. Sensitive troponin assay and the classification of myocardial infarction. Am J Med 2015;128:493-501.e3.
12. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al. Third universal definition of myocardial infarction. J Am Coll Cardiol 2012;60:1581-98.
13. Høiseth A, Neukamm A, Karlsson B, Omland T, Brekke P, 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.
14. Pavasini R, d'Ascenzo F, Campo G, Biscaglia S, Ferri A, Contoli M, et al. Cardiac troponin elevation predicts all-cause mortality in patients with acute exacerbation of chronic obstructive pulmonary disease: systematic review and meta-analysis. Int J Cardiol 2015;191:187-93.
15. Mannino DM, Thorn D, Swensen A, Holguin F. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur Respir J 2008;32:962-9.
16. 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 medicine. 2003;29:584-9.
17. Brekke P, Omland T, Holmedal S, Smith P, Søyseth V. Troponin T elevation and long-term mortality after chronic obstructive pulmonary disease exacerbation. Eur Respir J 2008;31:563-70.
18. Fruchter O, Yigla M. Cardiac troponin-I predicts long-term mortality in chronic obstructive pulmonary disease. COPD 2009;6:155-61.
19. Martins C, Rodrigues M, Miranda V, Nunes J. Prognostic value of cardiac troponin I in patients with COPD acute exacerbation. Neth J Med 2009;67:341-9.
20. 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.
21. Snell N, Newbold P. The clinical utility of biomarkers in asthma and COPD. Curr Opin Pharmacol 2008;8:222-35.
22. Missov E, Calzolari C, Pau B. Circulating cardiac troponin I in severe congestive heart failure. Circulation 1997;96:2953-8.
23. Meyer T, Binder L, Hruska N, Luthe H, Buchwald AB. Cardiac troponin I elevation in acute pulmonary embolism is associated with right ventricular dysfunction. J Am Coll Cardiol 2000;36:1632-6.
24. Harvey MG, Hancox RJ. Elevation of cardiac troponins in exacerbation of chronic obstructive pulmonary disease. Emerg Med Australas 2004;16:212-5.
25. Babuin L, Jaffe AS. Troponin: the biomarker of choice for the detection of cardiac injury. CMAJ 2005;173:1191-202.
26. Omland T. New features of troponin testing in different clinical settings. J Intern Med 2010;268:207-17.
27. Favory R, Neviere R. Bench-to-bedside review: significance and interpretation of elevated troponin in septic patients. Crit Care 2006;10:224.
28. Marcun R, Sustic A, Brguljan PM, Kadivec S, Farkas J, Kosnik M, et al. Cardiac biomarkers predict outcome after hospitalisation for an acute exacerbation of chronic obstructive pulmonary disease. Int J Cardiol 2012;161:156-9.
29. Youssef ARI, Hassan ASA, El-Ghamry R, Ahmed AE. Serum troponin-I as a prognostic marker in acute exacerbated chronic obstructive pulmonary disease patients. Egypt J Chest Dis Tuberc 2013;62:549-55.
30. Hasaneena N, Abd Elrahmana A, El Mahdya M, El Shaerb O, Hassanc M, El-Habashyd M. Positive cTnI in AECOPD patients may suggest exacerbation severity, the need for mechanical ventilation (MV), and longer duration of hospitalization. Egypt J Broncho. 2019;9:14-9.
31. Yıldırım F, Esquinas AM. Cardiac troponin trends and severity in chronic obstructive pulmonary disease exacerbation: Are limits properly associated for Intensive Care Unit outcome? Lung India 2016;33:583-4.
32. Gupta S, Saini V, Kaur J, Jaswal S, Kaur H, Kaur S. Cardiac troponin I as mortality predictor in acute exacerbation of chronic obstructive pulmonary disease. Int J Res Med Sci 2017;5:2669.
33. Raji H, Valipour A, Moradi M, Dastoorpoor M, Malamir MD, Ghanbaran A. The Prognostic Value of Cardiac Troponin I in Acute Exacerbation Phase of Chronic Obstructive Pulmonary Disease. Curr Respir Med Rev 2018;14:161-5.
34. Boschetto P, Beghe B, Fabbri LM, Ceconi C. Link between chronic obstructive pulmonary disease and coronary artery disease: implication for clinical practice. Respirology 2012;17:422-31.
35. Hawkins NM, Virani S, Ceconi C. Heart failure and chronic obstructive pulmonary disease: the challenges facing physicians and health services. Eur Heart J 2013;34:2795-807.
36. Campo G, Pavasini R, Malagu M, Mascetti S, Biscaglia S, Ceconi C, et al. Chronic obstructive pulmonary disease and ischemic heart disease comorbidity: overview of mechanisms and clinical management. Cardiovasc Drugs Ther 2015;29:147-57.
37. Campo G, Pavasini R, Pollina A, Tebaldi M, Ferrari R. On-treatment platelet reactivity in patients with chronic obstructive pulmonary disease undergoing percutaneous coronary intervention. Thorax 2014;69:80-1.
38. Campo G, Pavasini R, Malagù M, Punzetti S, Napoli N, Guerzoni F, et al. Relationship between troponin elevation, cardiovascular history and adverse events in patients with acute exacerbation of COPD. COPD 2015;12:560-7.
39. Høiseth AD, Omland T, Hagve TA, Brekke PH, Søyseth V. Determinants of high-sensitivity cardiac troponin T during acute exacerbation of chronic obstructive pulmonary disease: a prospective cohort study. BMC Pulm Med 2012;12:22.
| Files | ||
| Issue | Vol 60, No 5 (2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/acta.v60i5.9554 | |
| Keywords | ||
| Cardiac troponin I Chronic obstructive pulmonary disease Exacerbation Emergency | ||
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How to Cite
1.
Shahsavarinia K, Moghadasian Niaki N, Taghizadieh A, Habibi P, Separham A, Gilani N, Dolatkhah N. Serum Concentrations of Cardiac Troponin I Is Correlated With the Outcomes of Patients With Chronic Obstructive Pulmonary Disease Exacerbation Referred to Emergency Department. Acta Med Iran. 2022;60(5):275-282.
