Document Detail


Biochemical markers of cardiac dysfunction predict mortality in acute exacerbations of COPD.
MedLine Citation:
PMID:  21474497     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Retrospective studies suggest that plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin T are often elevated in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) and are associated with increased mortality. These cardiac biomarkers were investigated in an unselected cohort of patients admitted to hospital with exacerbations of COPD.
METHODS: Consecutive patients with physician-diagnosed COPD exacerbation but without clinical evidence of acute cardiac disease admitted to a public hospital over a 1 year period were studied prospectively. NT-proBNP and troponin T were measured on admission. The primary end point was all-cause mortality at 30 days.
RESULTS: Elevated NT-proBNP (>220 pmol/l) was present in 65/244 patients (27.5%) and significantly predicted 30-day mortality (OR 9.0, 95% CI 3.1 to 26.2, p<0.001). Elevated troponin T (>0.03 μg/l) was found in 40/241 patients (16.6%) and also predicted 30-day mortality (OR 6.3, 95% CI 2.4 to 16.5, p<0.001). These associations persisted after adjusting for other clinical and laboratory predictors of mortality (arterial CO(2) pressure (Paco(2)), body mass index and CURB65 score). NT-proBNP and troponin T levels appeared to have additive associations with mortality: 30-day mortality among patients with abnormalities of both NT-proBNP and troponin T was 15-fold higher than among patients with normal values.
CONCLUSION: Elevated levels of NT-proBNP and troponin T are strong predictors of early mortality among patients admitted to hospital with acute exacerbations of COPD independently of other known prognostic indicators. The pathophysiological basis for this is unknown, but indicates that cardiac involvement in exacerbations of COPD may be an important determinant of prognosis.
Authors:
Catherina L Chang; Scott C Robinson; Graham D Mills; Glenda D Sullivan; Noel C Karalus; John D McLachlan; Robert J Hancox
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-04-07
Journal Detail:
Title:  Thorax     Volume:  66     ISSN:  1468-3296     ISO Abbreviation:  Thorax     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-08-18     Completed Date:  2011-11-02     Revised Date:  2012-02-27    
Medline Journal Info:
Nlm Unique ID:  0417353     Medline TA:  Thorax     Country:  England    
Other Details:
Languages:  eng     Pagination:  764-8     Citation Subset:  IM    
Affiliation:
Department of Respiratory Medicine, Waikato Hospital, Level 01 Menzies Building, Hamilton 3204, New Zealand. contact_cat@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Biological Markers / blood*
Cause of Death / trends
Female
Follow-Up Studies
Heart Diseases / blood*,  etiology,  mortality
Humans
Male
Natriuretic Peptide, Brain / blood
New Zealand / epidemiology
Peptide Fragments / blood
Prognosis
Protein Precursors
Pulmonary Disease, Chronic Obstructive / blood*,  complications,  mortality
Recurrence
Retrospective Studies
Risk Factors
Survival Rate / trends
Time Factors
Troponin T / blood
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Peptide Fragments; 0/Protein Precursors; 0/Troponin T; 0/pro-brain natriuretic peptide (1-76); 114471-18-0/Natriuretic Peptide, Brain
Comments/Corrections
Comment In:
Thorax. 2012 Feb;67(2):177-8; author reply 178   [PMID:  21685493 ]
Thorax. 2011 Sep;66(9):745-7   [PMID:  21653929 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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