Bhaskar Kanti Nath, Abhishrut Pramod Jog, Prithwiraj Bhattacharjee, Manish Jain, Atanu Basumatary,
BACKGROUND
Cardiovascular disease is commonly seen in patients with Chronic Obstructive Pulmonary Disease (COPD). Brain Natriuretic Peptide (BNP) is a marker of ventricular dysfunction and troponin T of myocardial necrosis. Elevations of these markers have been found in many disorders, COPD being one of them. The aim of the study is to assess the association of elevated cardiac biomarkers with the 6-month mortality in patients with Acute Exacerbation of COPD (AECOPD)
. MATERIALS AND METHODS
86 patients admitted with acute exacerbation of COPD were included in this prospective study. Cardiac Biomarkers- BNP and troponin-T were measured on admission. Patients were followed up for the next 6 months and mortality over this duration was recorded and analysed. Statistical Analysis- Pearson X2 testing was used. Setting and Design- The study was conducted in the Department of Medicine, Silchar Medical College and Hospital, Silchar, Assam. It was a prospective hospital-based observational study
RESULTS
Four groups based on the cardiac biomarker elevation pattern were seen- (1) With no elevation of cardiac biomarkers - 62.8% (54/86); (2) With elevation of troponin alone- 17.4% (15/86); (3) With elevation of BNP alone- 7% (6/86); and (4) With elevation of both BNP and troponin T- 12.8% (11/86). Over 6 months, a total of 16.27% (14/86) died. (1) In the group with no elevation- 3.7% (3/54) deaths occurred. (2) In the group with only troponin elevation- 33.3% (5/15) deaths occurred showing a statistical significance (p=0.004; RR=9.0). (3) In the group with only BNP elevation- 16.7% (1/6) deaths occurred, but were statistically insignificant (p=0.275). (4) The group with elevation of both BNP and troponin-T had- 45.5% (5/11) deaths achieving the highest statistical significance (p=0.000; RR=12.3).
CONCLUSION
In COPD patients presenting with acute exacerbation, an isolated elevation of troponin level or a combined elevation of BNP and troponin-T levels are strong predictors of mortality (9 fold and 12 fold increase respectively). However, elevated BNP in isolation is not associated with increased mortality
