Serum Troponin-I as a prognostic marker in acute exacerbated chronic obstructive pulmonary disease patients

Background: Chronic Obstructive Pulmonary Disease (COPD) is a major cause of chronic morbidity and mortality worldwide. It is the fifth leading cause of death worldwide. The spectrum of cardiovascular complications associated with COPD is clearly broad, right ventricular (RV) dysfunction and pulmonary vascular disease are common in COPD and progress with time. In RV failure, cardiac Troponins (cTn) are suspected to be elevated secondary to RV ischemia or micro infarction. Objective: To evaluate the prognostic value of cardiac Troponin I level in acute exacerbated chronic obstructive pulmonary diseases (AECOPD) and its impact on the hospital outcome in those patients. Patients and methods: This study was performed on 60 patients with AECOPD, admitted at Chest Department and respiratory ICU; Zagazig University hospital. All patients were subjected to: thorough history taking, clinical examination, electrocardiography and echocardiography, arterial blood gas (ABG) analysis, measure forced vital capacity (FVC) and forced expiratory volume in first second (FEV1), serum assay of cTnI level which is considered −ve if <0.01 ng/ml and +ve if ⩾0.01 ng/ml. Results: cTnI was positive in 42 AECOPD patients. cTnI positivity was more prominent among patients with very severe exacerbation of COPD and in those with past history of LTOT, MV, ICU admission. Also, cTnI positivity was more in patients admitted to ICU rather than those managed in the ward and among patients who needed MV rather than who did not need it and in patients who failed weaned rather that who succeeded weaned. P-pulmonate, Rt. ventricular strain, high pulmonary artery pressure, hypoxemia and hypercapnia showed a great effect upon cTnI positivity. The duration of hospitalization was longer among cTnI +ve patients than cTnI −ve ones, Tropinin cutoff value for the prediction of death was >0.055 ng/ml with Sensitivity = 75%, Specificity = 68%. Conclusion: Positive cTnI in AECOPD patients may suggest exacerbation severity and the occurrence of pulmonary hypertension and right ventricular dysfunction. Positive cTnI is considered as good prognostic marker for the possibility of a need for MV and a longer duration of hospitalization. MV may further elevate cTnI in AECOPD patients and with possible weaning failure. Negative cTnI and cTnI ⩽ 0.055 μg/L can be considered predictors of survival in AECOPD patients