Issue: 2009 > November > original article

Prognostic value of cardiac troponin I in patients with COPD acute exacerbation

C.S. Martins, M.J.O. Rodrigues, V.P. Miranda, J.P.L. Nunes


Background: Chronic obstructive pulmonary disease
(COPD) is frequently associated with right ventricular
loading and pulmonary hypertension. We aimed to evaluate a possible association between cardiac troponin I (cTnI) levels and adverse events in hospitalised patients with acute exacerbation of COPD .
Methods: Retrospective cohort study, with analysis of
admissions for acute exacerbation of COPD , with cTnI
obtained in the first 48 hours of admission. A positive
cTnI test was defined as 0.012 ng/ml or higher (99th
percentile). Baseline and peak troponin I levels were taken as independent variables, and outcome variables included length of hospital stay, complications during hospitalisation, and in-hospital and extra-hospital mortality (evaluated 18 months post-discharge).
Results: Data concerned 173 patients (105 male, 68 female), with a median age of 77 years (interquartile range of 11 years). The median baseline cTnI was 0.030 ng/ml (n=173), and the median peak cTnI was 0.040 ng/ml (n=173; absolute peak value of 1.260 ng/ml). Nearly 70% of cases had a positive cTnI at admission. Both baseline and peak cTnI correlated significantly with the need for noninvasive ventilatory support. We were not able to find significant differences in in-hospital survival associated with the two troponin groups, but overall 18-month survival was significantly higher among patients with lower values of baseline and peak cTnI. Conclusions: In patients hospitalised for acute COPD exacerbations, elevated baseline and peak cTnI were associated with a greater need for noninvasive ventilatory support and were significant predictors of 18-month overall survival.