Cardiac troponin I in patients with severe exacerbation of chronic obstructive pulmonary disease
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- Baillard, C., Boussarsar, M., Fosse, JP. et al. Intensive Care Med (2003) 29: 584. doi:10.1007/s00134-003-1635-0
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Co-morbid conditions including risk factors for cardiovascular diseases and left ventricular dysfunction are common in patients with chronic obstructive pulmonary disease (COPD). This study assessed the incidence of cardiac troponin I (cTnI) elevation, a specific marker for cardiac injury, and its prognostic significance during severe exacerbation of COPD.
Prospective cohort study.
Two intensive care units.
Seventy-one consecutive patients admitted for severe exacerbation of COPD.
Measurements and results
Cardiac troponin I was assayed in blood samples obtained on admission and 24 h later (Stratus II immunoassay analyser, Dade International). Levels above 0.5 ng/ml were considered positive. The following data were recorded prospectively: clinical symptoms, co-morbidities, cause of the exacerbation, diagnostic procedures and treatment, general severity score (SAPS II) and in-hospital outcome. CTnI was positive in 18% of patients (95% confidence interval (CI95), 11–29%), with a median value at 1.00 ng/ml; CI95 (0.60–1.70). Eighteen patients died in the hospital (25%; CI95, 17–37%). Only cTnI (adjusted odds ratio (ORa), 6.52; CI95,1.23–34.47) and SAPS II 24 h after admission (ORa, 1.07; CI95, 1.01–1.13) were independent predictors of in-hospital mortality.
Elevated cTnI is a strong and independent predictor of in-hospital death in patients admitted for acutely exacerbated COPD.