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

E. Shafuddin, S.M. Fairweather, C.L. Chang, C. Tuffery, R.J. Hancox
ERJ Open Research 2020; DOI: 10.1183/23120541.00531-2020
E. Shafuddin
1Department of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand
3Co-first authors
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  • For correspondence: eskandarain.shafuddin@waikatodhb.health.nz
S.M. Fairweather
1Department of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand
3Co-first authors
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C.L. Chang
1Department of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand
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C. Tuffery
1Department of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand
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R.J. Hancox
1Department of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand
2Department of Preventive and Social Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
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Abstract

Background Chronic obstructive pulmonary disease (COPD) patients often have cardiac comorbidities. Cardiac involvement at the time of a COPD exacerbation is associated with a high short-term mortality, but whether this influences long-term outcomes is unknown. We explored whether biomarkers of cardiac dysfunction at the time of a COPD exacerbation predict long term outcomes.

Methods Two prospective cohorts of patients admitted to Waikato hospital for exacerbations of COPD were recruited during 2006–2007 and 2012–2013. N-terminal proBNP (NT-proBNP) and troponin T were measured on admission and were used to indicate cardiac stretch and myocardial injury respectively. Five-year survival after discharge and subsequent admissions for cardiac disease and COPD exacerbations were analysed using Kaplan-Meier and Cox proportional hazards tests.

Results The overall 5-year mortality was 61%. Patients with high NT-proBNP on admission had higher mortality than those with normal cardiac biomarkers (adjusted Hazard Ratio (aHR) 1.76, 95% CI 1.18–2.62). High NT-proBNP was also associated with a higher risk of future cardiac admissions (aHR 1.75 95% CI 1.2–2.55). Troponin T levels were not associated with long-term survival (aHR 0.86 95 CI 0.40–1.83) or future cardiac admissions (aHR 0.74, 95% CI 0.34–1.57). Neither biomarker predicted future COPD exacerbations.

Conclusion The long-term prognosis following a hospitalisation for an exacerbation of COPD is poor with less than half of patients surviving for 5 years. Elevated NT-proBNP at the time of a COPD exacerbation is associated with higher long-term mortality and a greater likelihood of future cardiac admissions, but not future COPD exacerbations.

Footnotes

This manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.

Conflict of interest: Dr. SHAFUDDIN has nothing to disclose.

Conflict of interest: Ms. FAIRWEATHER has nothing to disclose.

Conflict of interest: Dr. CHANG has nothing to disclose.

Conflict of interest: Ms. TUFFERY has nothing to disclose.

Conflict of interest: Dr. HANCOX has nothing to disclose.

This is a PDF-only article. Please click on the PDF link above to read it.

  • Received July 28, 2020.
  • Accepted November 26, 2020.
  • Copyright ©ERS 2020
http://creativecommons.org/licenses/by-nc/4.0/

This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

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Cardiac biomarkers and long-term outcomes of exacerbations of COPD: a long-term follow-up of two cohorts
E. Shafuddin, S.M. Fairweather, C.L. Chang, C. Tuffery, R.J. Hancox
ERJ Open Research Jan 2020, 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
E. Shafuddin, S.M. Fairweather, C.L. Chang, C. Tuffery, R.J. Hancox
ERJ Open Research Jan 2020, 00531-2020; DOI: 10.1183/23120541.00531-2020
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