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Cardiac biomarkers and long-term outcomes of exacerbations of COPD: a long-term follow-up of two cohorts

Eskandarain Shafuddin, Sarah M. Fairweather, Catherina L. Chang, Christine Tuffery, Robert J. Hancox
ERJ Open Research 2021 7: 00531-2020; DOI: 10.1183/23120541.00531-2020
Eskandarain Shafuddin
1Dept of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand
3These authors contributed equally.
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  • For correspondence: eskandarain.shafuddin@waikatodhb.health.nz
Sarah M. Fairweather
1Dept of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand
3These authors contributed equally.
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Catherina L. Chang
1Dept of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand
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Christine Tuffery
1Dept of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand
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Robert J. Hancox
1Dept of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand
2Dept of Preventive and Social Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
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  • ORCID record for Robert J. Hancox
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  • FIGURE 1
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    FIGURE 1

    Study design. Patients who died in hospital (n=17) were included in overall mortality data but were excluded from survival analyses after discharge. NT-proBNP: N-terminal pro-B-type natriuretic peptide.

  • FIGURE 2
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    FIGURE 2

    Kaplan–Meier curve of survival over 5 years after discharge for exacerbation of COPD. HR adjusted for CURB-65, acidaemia (pH<7.30) and forced expiratory volume in 1 s (% pred). aHR: adjusted hazard ratio; NT-proBNP: N-terminal pro-B-type natriuretic peptide.

  • FIGURE 3
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    FIGURE 3

    Kaplan–Meier curve of subsequent COPD hospitalisations following discharge after index COPD exacerbation. HR adjusted for CURB-65, acidaemia (pH<7.30) and forced expiratory volume in 1 s (% pred). aHR: adjusted hazard ratio; NT-proBNP: N-terminal pro-B-type natriuretic peptide.

  • FIGURE 4
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    FIGURE 4

    Kaplan–Meier curve of subsequent cardiac hospitalisations over 5 years following discharge after index COPD exacerbation. HR adjusted for CURB-65, acidaemia (pH<7.30) and forced expiratory volume in 1 s (% pred). aHR: adjusted hazard ratio; NT-proBNP: N-terminal pro-B-type natriuretic peptide.

Tables

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  • TABLE 1

    Baseline characteristics

    CharacteristicSubjectsValue
    Age years40970.1 (69–71.2)
    BMI kg·m−240124.6 (23.9–25.2)
    Current smoker409126 (31)
    FEV1 L4040.79 (0.76–0.83)
    FEV1 % pred40434.7 (33.3–36.2)
    Acidaemia#36456 (15)
    PaCO2 mmHg31547.9 (46.3–49.7)
    PaO2 mmHg31263.8 (61.5–66.2)
    History of cardiac disease409152 (37)
    History of malignancy40942 (10)
    Cardiac medication on admission
     β-blocker40945 (11)
     Calcium-channel blocker40997 (24)
     Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker409158 (39)
     Diuretic409152 (37)
     Antiplatelet409159 (39)
     Anticoagulation40928 (7)
     Statin409116 (28)
    Cardiac biomarker levels at presentation
     NT-proBNP pmol·L−140562.5 (53.7–72.7)
     Troponin T
       Cohort 1 µg·L−12390.015 (0.014–0.017)
       Cohort 2 ng·L−116218.3 (16.2–20.7)
    Mortality
     In-hospital40117 (4)
     30-day40129 (7)
     1-year40182 (20)
     2-year401133 (33)
     5-year401245 (61)

    Data are presented as geometric mean (95% CI) or n (%). Mortality data excluded eight patients who did not have both cardiac biomarkers measured on admission. BMI: body mass index; FEV1: forced expiratory volume in 1 s; NT-proBNP: N-terminal pro-B-type natriuretic peptide; PaCO2: arterial carbon dioxide tension; PaO2: arterial oxygen tension. #: blood pH <7.3.

    • TABLE 2

      Combined cohort adjusted and unadjusted hazard ratios (HRs) for 5-year survival, exacerbation-free survival and cardiac admission-free survival following discharge after index COPD admission according to cardiac biomarker status

      UnadjustedAdjusted
      SubjectsHR (95% CI)p-valueSubjectsHR (95% CI)p-value
      Survival384337
       High troponin T only0.89 (0.43–1.80)0.7380.86 (0.40–1.83)0.691
       High NT-proBNP only2.13 (1.52–2.99)<0.0011.76 (1.18–2.62)0.005
       Both high2.82 (1.87–4.26)<0.0012.28 (1.44–3.60)<0.001
      Exacerbation-free survival384337
       High troponin T only1.03 (0.60–1.77)0.9060.91 (0.49–1.66)0.753
       High NT-proBNP only1.17 (0.86–1.58)0.3201.10 (0.78–1.54)0.603
       Both high1.29 (0.88–1.89)0.1961.27 (0.83–1.95)0.277
      Cardiac admission-free survival384337
       High troponin T only0.87 (0.44–1.70)0.6810.74 (0.34–1.57)0.431
       High NT-proBNP only2.13 (1.54–2.95)<0.0011.75 (1.20–2.55)0.003
       Both high2.55 (1.70–3.84)<0.0011.98 (1.25–3.12)0.003

      HR adjusted for CURB65, acidaemia (pH<7.30) and % of predicted forced expiratory volume in 1 s. NT-proBNP: N-terminal pro-B-type natriuretic peptide.

      Supplementary Materials

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        Supplementary material 00531-2020.SUPPLEMENT

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      Cardiac biomarkers and long-term outcomes of exacerbations of COPD: a long-term follow-up of two cohorts
      Eskandarain Shafuddin, Sarah M. Fairweather, Catherina L. Chang, Christine Tuffery, Robert J. Hancox
      ERJ Open Research Jan 2021, 7 (1) 00531-2020; DOI: 10.1183/23120541.00531-2020

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      Cardiac biomarkers and long-term outcomes of exacerbations of COPD: a long-term follow-up of two cohorts
      Eskandarain Shafuddin, Sarah M. Fairweather, Catherina L. Chang, Christine Tuffery, Robert J. Hancox
      ERJ Open Research Jan 2021, 7 (1) 00531-2020; DOI: 10.1183/23120541.00531-2020
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