Cardiac biomarkers predict outcome after hospitalisation for an acute exacerbation of chronic obstructive pulmonary disease
Introduction
Clinical management of chronic obstructive pulmonary disease (COPD) focuses primarily on symptom control and prevention of exacerbations. As a result repeat hospitalisation should be regarded as a relevant end-point in patients with COPD [1]. This is particularly true in hospitalized patients as about 30–50% will be rehospitalized within 6 months after discharge [1], [2]. The identification of risk predictors others than those previously reported would therefore be both of considerable importance in planning strategies to reduce disease burden and have significant financial implications. With growing awareness of and scientific interest in comorbidities associated with COPD, cardiac biomarkers are an attractive option to investigate [3], [4].
Several studies have demonstrated an association between cardiac laboratory biomarkers and survival in patients managed for an acute exacerbation of COPD [5], [6], [7], [8], [9], [10], [11], [12]. Much more limited information is available, however, for the prediction of rehospitalisations. There remains some uncertainty about the applicability and clinical implications of the published results as some studies were retrospective, did not control for left ventricular function, and have focused on all-cause mortality. In addition, most of the studies analysed cardiac biomarkers only once during deterioration and the timing of the blood sampling was different across the reported studies.
We have thus designed this study to address the relationship between cardiac biomarkers and short-term outcome in patients hospitalized for acute exacerbation of COPD. Our specific aim was to investigate whether different time-points of biomarker evaluation affects short-term patient outcome.
Section snippets
Study design and patients
We conducted a prospective observational study in patients admitted for an acute exacerbation of COPD. Study design, patient inclusion and exclusion criteria were as detailed previously [13]. For this analysis, all admitted patients to our hospital were assessed for study eligibility. Patients with a clinical diagnosis of acute exacerbation of COPD on admission were approached for study participation if they were in Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages II–IV [1]
Results
Table 1 summarizes the baseline characteristics of the final sample of 127 patients. They were predominantly males with advanced COPD, a significant smoking history, with various comorbidities, and receiving COPD specific therapy according to guidelines. Left ventricular dysfunction was detected in 70 (55%) patients and diastolic dysfunction was the most common finding (53 patients — 42%). NT-proBNP and TnT were measured at admission and discharge; elevated values were recorded in 60%, 36%,
Discussion
This is the most comprehensive prospective study to report associations between cardiac biomarkers determined at different time-points during hospitalisation for acute exacerbation of COPD and short term prognosis. We were able to confirm previous findings that NT-proBNP and TnT predict patient outcome. In addition to that, we report specifically about differences in timing and the type of event: NT-proBNP on admission predicted mortality whilst TnT at discharge predicted re-hospitalisation.
A
Clinical implications and conclusions
An abundant literature supports an important involvement of abnormalities in the cardiovascular system in the prognosis of patients with COPD [28], [29], [30]. Our results support more detailed cardiovascular evaluation in patients with an acute exacerbation of COPD. Elevated NT-proBNP on admission and TnT at discharge should perhaps trigger further patient investigation to identify causative factors and to risk-stratify the patients for the risk of adverse short-term outcome. As cardiovascular
References (32)
- et al.
Use of B-type natriuretic peptide in the risk stratification of acute exacerbations of COPD
Chest
(2008) - et al.
Prognostic utility of NT-proBNP in acute exacerbation of chronic pulmonary disease
Eur J Intern Med
(2011) - et al.
Midregional proatrial natriuretic peptide predicts survival in exacerbations of COPD
Chest
(2011) - et al.
Effectiveness of discharge-coordinator intervention in patients with chronic obstructive pulmonary disease: study protocol of a randomized controlled clinical trial
Respir Med
(2011) - et al.
Ethics in the authorship and publishing of scientific articles
Int J Cardiol
(2010) - et al.
How often we need to measure brain natriuretic peptide (BNP) blood levels in patients admitted to the hospital for acute severe heart failure? Role of serial measurements to improve short-term prognostic stratification
Int J Cardiol
(2010) - et al.
Usefulness of mid regional pro-atrial natriuretic peptide in the exacerbations of chronic obstructive pulmonary disease
Clin Chim Acta
(2011) - et al.
Reduction of morbidity and mortality by statins, angitensin-converting enzyme inhibitors, and angiotensin receptor blockers in patient with chronic obstructive pulmonary disease
J Am Coll Cardiol
(2006) - et al.
The impact of ischemic heart disease on symptoms, health status, and exacerbations in patients with COPD
Chest
(2012) - et al.
Global strategy for the diagnosis, management and prevention of COPD — 2006 update
Am J Respir Crit Care Med
(2007)
Chronic obstructive pulmonary disease: current burden and future projections
Eur Respir J
Systemic manifestations and comorbidities of COPD
Eur Respir J
Neurohormonal activation and inflammation in chronic cardiopulmonary disease: a brief systematic review
Wien Klin Wochenschr
Troponin T elevation and long-term mortality after chronic obstructive pulmonary disease exacerbation
Eur Respir J
Cardiac troponin-I predicts long-term mortality in chronic obstructive pulmonary disease
COPD
Prognostic value of cardiac troponin I in patients with COPD acute exacerbation
Neth J Med
Cited by (54)
Abnormalities in cardiac and inflammatory biomarkers in ambulatory subjects after COVID-19 infection
2022, IJC Heart and VasculatureCitation Excerpt :Cardiac and inflammatory biomarkers have been reported to be elevated in acute COVID-19 infection, especially among individuals requiring hospitalization and intensive care unit [5,6]. Elevations in cardiac troponins and NT-pro-B-type natriuretic peptide (BNP) are associated with increased risks of re-hospitalization, CV complications and death after COVID-19 infection [7]. However, most studies of COVID-19 serum biomarkers, particularly cardiac biomarkers, have been reported in hospitalized COVID-19 patients [8].
Heart failure in patients with COPD exacerbations: Looking below the tip of the iceberg
2022, Respiratory MedicineRole of Cardiac Biomarkers in COVID-19: What Recent Investigations Tell Us?
2021, Current Problems in CardiologyAn emergency medicine approach to troponin elevation due to causes other than occlusion myocardial infarction
2020, American Journal of Emergency MedicineChanges in biomarkers of cardiac dysfunction during exacerbations of chronic obstructive pulmonary disease
2018, Respiratory MedicineCitation Excerpt :The time-course of cardiac biomarkers during acute exacerbations of COPD has not been carefully documented and previous studies report conflicting results [11,15–22]. Patel et al. reported that NT-proBNP and troponin T remained high for up to five weeks after the exacerbation [11], while other studies reported that the levels of cardiac biomarkers gradually declined within days to a few weeks after an exacerbation [15,17,19,21,22]. However, none of these studies investigated the changes in cardiac biomarkers during the first few days of the acute exacerbation.
NT-proBNP in stable COPD and future exacerbation risk: Analysis of the SPIROMICS cohort
2018, Respiratory MedicineCitation Excerpt :Natriuretic peptide levels increase during acute exacerbations of COPD and return to baseline after successful treatment [13,14]. Higher NT-proBNP levels measured at the time of a COPD exacerbation have been associated with increased need for intensive care [15] and higher mortality [16–19]. However, the role of NT-proBNP as a prognostic biomarker in stable COPD has not been fully investigated.