Cardiac troponin elevation predicts all-cause mortality in patients with acute exacerbation of chronic obstructive pulmonary disease: Systematic review and meta-analysis. (15th July 2015)

• Record Type: Journal Article
• Authors: Pavasini, Rita; d'Ascenzo, Fabrizio; Campo, Gianluca; Biscaglia, Simone; Ferri, Alessandra; Contoli, Marco; Papi, Alberto; Ceconi, Claudio; Ferrari, Roberto
• Is Part Of: International journal of cardiology. Volume 191(2015)
• Page Start: 187
• Page End: 193
• Publication Date: 2015-07-15
• Subjects: IHD ischemic heart disease -- COPD chronic obstructive pulmonary disease -- AECOPD acute exacerbation of COPD -- Tn troponin -- HR hazard ratio -- OR odds ratio -- URL upper reference limit -- PRISMA preferred reporting items for systematic reviews and meta-analyses -- QUOROM quality of reporting of meta-analyses -- MOOSE meta-analysis of observational studies in epidemiology -- HS high sensitivity -- HF heart failure -- MI myocardial infarction; Chronic obstructive pulmonary disease -- Troponin -- Mortality -- Outcome -- Exacerbation; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2015.05.006
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Cardiovascular disease, especially ischemic heart disease, is a major comorbidity in chronic obstructive pulmonary disease (COPD) patients. Several studies suggested that after acute exacerbation of COPD (AECOPD), there is a significant increase of mortality (cardiac and all-cause) and of myocardial infarction. Whether cardiac troponin (Tn) elevation during AECOPD could be considered a prognostic marker of all-cause mortality is still debated. Methods: To assess the prognostic role of cardiac Tn elevation during AECOPD, we performed a systematic review and meta-analysis. We included studies with patients admitted to the hospital for AECOPD, with at least one Tn assessment and reporting the relationship (after multivariable analysis) between Tn elevation and all-cause mortality. Secondarily, studies were stratified according to: i) type of troponin (Tn I or Tn T), and ii) follow-up length (≤ 6 months vs. > 6 months). Results: Ten studies were included in the systematic review and 8 in the meta-analysis. Cardiac Tn elevation ranges from 18% to 73%. We found that cardiac Tn elevation was significantly related to an increased risk for all-cause mortality (OR 1.69; 95% CI 1.25–2.29; I 2 40%). This finding was independent to the follow-up length of studies (≤ 6 months: OR 3.22; 95% CI 1.31–7.91; > 6 months: OR 1.38; 95% CI 1.02–1.86). Finally, Tn T seems to be more helpful in predicting all-cause mortality as compared to Tn I (OR 1.54; 95% CI 1.2–1.96 vs. OR 3.39, 95% CI 0.86–13.36, respectively). Conclusions: In patients admitted to the hospital for AECOPD, cardiac Tn elevation emerged as an independent predictor of increased risk of all-cause mortality.