Role of cardiac biomarkers in patients of chronic obstructive pulmonary disease with acute exacerbation

• Published in: Indian journal of medical specialities Vol. 13; no. 3; pp. 161 - 165
• Main Authors: Raghu, R, Mawari, Govind, Kumar, Naresh, Daga, Mradul, Gautam, Sachin, Aarthi, J, Chand, Siddharth, Ritchie, Nupur, Rana, Gunjan, Acharya, Shubho, Sen, Parikshit, Chaudhary, Divyansh, Kain, Pratischtha, Garg, Nishant, Bhoria, Dhruv
• Format: Journal Article
• Language: English
• Published: Wolters Kluwer India Pvt. Ltd 01-07-2022; Medknow Publications and Media Pvt. Ltd
• Subjects: Biological markers; Cardiac patients; Creatine kinase; Lung diseases, Obstructive; Medical research; Medicine, Experimental; Mortality; Natriuretic peptides; creatine phosphokinase-MB; cardiac dysfunction; troponin-T; Cardiac biomarkers; pro-brain natriuretic peptide; chronic obstructive pulmonary disease
• ISSN: 0976-2884; 0976-2892
• DOI: 10.4103/injms.injms_4_22

Background: Patients with chronic obstructive pulmonary disease (COPD) often have cardiovascular comorbidities. Patients of COPD with cardiovascular complications tend to have more symptoms and a higher mortality than do patients with COPD alone. There are several cardiac biomarkers such as Troponin-T, creatine phosphokinase-MB (CPK-MB), and N-terminal pro-brain natriuretic peptide (NT-proBNP) which can be used to detect cardiac dysfunction in patients of COPD. Retrospective studies suggest that plasma levels of NT-proBNP and cardiac Troponin-T are often elevated in patients with acute exacerbations of COPD and are associated with increased mortality. Aims and objectives: In this study, we assessed the presence of cardiac dysfunction in patients presenting with acute exacerbation of COPD (AECOPD) by using cardiac biomarkers proBNP, Troponin-T, and CPK-MB. Patients were followed up for 30 days to know the relationship between cardiac dysfunction and outcome in terms of repeated admissions, intensive care units (ICU) admissions, and/or mortality. Methodology: Ninety patients of AECOPD were enrolled in our study. A detailed history was taken and physical examination performed in these patients. All patients in the study were subjected to hematological and biochemical investigations. ProBNP, Troponin-T, and CPK-MB were measured within 48 h of admission as measure of cardiac dysfunction; and outcome was assessed in terms of mortality, ICU admission, and repeated admissions within 30 days of admission. Results: Among the study population, 77.77% had at least one deranged cardiac biomarker, and 18.88% of populations had all the three biomarkers of cardiac dysfunction deranged. 24 out of the 90 participants required ventilatory support in the form of noninvasive or invasive ventilation. 7.14% of the study population had repeated admissions, 24.28% had ICU admissions and 11.43% had mortality. All of them had deranged cardiac biomarkers. There was a significant association between deranged proBNP and ICU admission and mortality (P = 0.0151 and 0.0217, respectively). COPD was more prevalent in the age group of 50-70 years and in males. ProBNP levels were significantly elevated in patients who required ventilatory support (P = 0.003). Conclusions: Cardiac dysfunction is common during exacerbations of COPD and portends a poor prognosis. Cardiac dysfunction was more prevalent in the elderly. Patients with deranged cardiac biomarkers had a greater number of ICU admissions, repeated hospital admissions, and a higher mortality. In the follow-up, elevated proBNP was found to be a strong marker for predicting ICU admission, mortality, and repeated admissions.