Abstract
BackgroundCardiac Troponin T (cTnT) elevation during exacerbations of chronic obstructive pulmonary disease (COPD) is associated with increased mortality the first year after hospital discharge. The factors associated with cTnT elevation in COPD are not known.MethodsFrom our hospital's database, all patients admitted with COPD exacerbation in 2000–03 were identified. 441 had measurement of cTnT performed. Levels of cTnT ≥ 0.04 μg/l were considered elevated. Clinical and historical data were retrieved from patient records, hospital and laboratory databases. Odds ratios for cTnT elevation were calculated using logistic regression.Results120 patients (27%) had elevated cTnT levels. The covariates independently associated with elevated cTnT were increasing neutrophil count, creatinine concentration, heart rate and Cardiac Infarction Injury Score (CIIS), and decreasing hemoglobin concentration. The adjusted odds ratios (95% confidence intervals in parentheses) for cTnT elevation were 1.52 (1.20–1.94) for a 5 × 106/ml increase in neutrophils, 1.21 (1.12–1.32) for a 10 μmol/l increase in creatinine, 0.80 (0.69–0.92) for a 1 mg/dl increase in hemoglobin, 1.24 (1.09–1.42) for a 10 beats/minute increase in heart rate and 1.44 (1.15–1.82) for a 10 point increase in CIIS.ConclusionMultiple factors are associated with cTnT elevation, probably reflecting the wide panorama of comorbid conditions typically seen in COPD. The positive association between neutrophils and cTnT elevation is compatible with the concept that an exaggerated inflammatory response in COPD exacerbation may predispose for myocardial injury.
Highlights
Cardiac Troponin T elevation during exacerbations of chronic obstructive pulmonary disease (COPD) is associated with increased mortality the first year after hospital discharge
In a historic cohort study of patients hospitalized for COPD exacerbation, we found that patients with cardiac troponin T ≥ 0.04 μg/l had a mortality rate nearly twice as high as patients with no measurable Cardiac Troponin T (cTnT) in the first year after discharge. [10]
Coexisting cardiovascular conditions were common, with 24% of the patients having a diagnosis of arterial hypertension, 22% having a history of previous myocardial infarction (MI), 16% having diabetes mellitus, and 13% having a diagnosis of congestive heart failure
Summary
Cardiac Troponin T (cTnT) elevation during exacerbations of chronic obstructive pulmonary disease (COPD) is associated with increased mortality the first year after hospital discharge. Chronic Obstructive Pulmonary Disease (COPD) constitutes an increasing health burden worldwide, and is the only leading cause of death that still has a rising mortality rate in industrialized countries.[1] In addition to a slow progression of symptoms and deterioration of lung function, a large proportion of the patients experience episodes of symptom worsening, including increased sputum, cough and dyspnea (exacerbations).[2] During exacerbations, patients frequently need hospitalization, and mortality is increased. In a historic cohort study of patients hospitalized for COPD exacerbation, we found that patients with cardiac troponin T (cTnT) ≥ 0.04 μg/l had a mortality rate nearly twice as high as patients with no measurable cTnT in the first year after discharge. Cardiac troponin elevation is seen in a variety of conditions not directly related to flow-limiting coronary stenoses or occlusion of the coronary arteries, such as pulmonary embolism, septic shock, heart failure and stroke. [6,7,8,9] In these settings, it is well documented that elevated circulating levels of troponins are associated with poor prognosis, regardless of underlying disease.
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