Abstract
BackgroundA high-sensitivity cardiac troponin T (hs-cTnT) concentration above the 99th percentile (i.e. 14 ng/L) is common during Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) and associated with increased mortality. The objective of the study was to identify factors associated with hs-cTnT levels during AECOPD.MethodsWe included 99 patients with AECOPD on admission. As 41 patients had one or more repeat admissions, there were 202 observations in the final analysis. We recorded clinical and biochemical data, medication, spirometry, chest radiographs, and ECGs. The data were analysed for cross-sectional and longitudinal associations using ordinary least square as well as linear mixed models with the natural logarithm of hs-cTnT as the dependent variable.ResultsMean age at inclusion was 71.5 years, mean FEV1/FVC was 45%, and median hs-cTnT was 27.0 ng/L. In a multivariable model there was a 24% increase in hs-cTnT per 10 years increase in age (p < 0.0001), a 6% increase per 10 μmol/L increase in creatinine (p = 0.037), and a 2% increase per month after enrollment (p = 0.046). Similarly, the ratios of hs-cTnT between patients with and without tachycardia (heart rate ≥100/min) and with and without history of arterial hypertension were 1.25 (p = 0.042) and 1.44 (p = 0.034), respectively. We found no significant association between arterial hypoxemia and elevated hs-cTnT.ConclusionAge, arterial hypertension, tachycardia, and serum creatinine are independently associated with the level of hs-cTnT on admission for AECOPD.
Highlights
A high-sensitivity cardiac troponin T concentration above the 99th percentile (i.e. 14 ng/L) is common during Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) and associated with increased mortality
We recently showed that myocardial injury, defined as high-sensitivity cardiac troponin T above the 99th percentile (i.e. 14 ng/L), was present in 74% of patients admitted for acute exacerbation of chronic obstructive pulmonary disease (COPD) (AECOPD) and that such injury carried a markedly increased risk of subsequent mortality [13]
In a previous cross-sectional study among patients hospitalised for AECOPD, we found that cardiac troponin T measured with a 4th generation assay was positively associated with increasing serum creatinine, blood neutrophil cell count, and cardiac infarction injury score (CIIS), whereas it was negatively associated with hemoglobin level [14]
Summary
A high-sensitivity cardiac troponin T (hs-cTnT) concentration above the 99th percentile (i.e. 14 ng/L) is common during Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) and associated with increased mortality. Cardiovascular disease (CVD) is frequent in chronic obstructive pulmonary disease (COPD) [1,2,3,4,5] This is in part due to cigarette smoking being a strong common risk factor, but systemic effects of COPD are thought to independently promote CVD [6]. We recently showed that myocardial injury, defined as high-sensitivity cardiac troponin T (hs-cTnT) above the 99th percentile (i.e. 14 ng/L), was present in 74% of patients admitted for acute exacerbation of COPD (AECOPD) and that such injury carried a markedly increased risk of subsequent mortality [13]. The determinants of troponin elevation in AECOPD are, sparsely studied
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