Cardiac troponin I – A prognostic marker in acute exacerbation of chronic obstructive pulmonary disease

Abstract

Aim: The aim of this study is to assess the use of cardiac troponin I as a prognostic marker in the acute exacerbation of COPD. Objectives: Primary Objective: Evaluate the prevalence of elevation of cTnI in patients admitted with acute exacerbation of COPD. Secondary Objective: Evaluate the association of longer duration of COPD, lower SpO2 and higher PaCO2 at admission, increased need for ventilatory support, increased duration of hospital stay and increased inhospital mortality in cTnI positive patients. Material And Methods: Study Site: Apollo Main Hospital, Chennai Study Population: Patients greater than 40 years with spirometry confirmed COPD according to GOLD guidelines admitted with AECOPD in the emergency or ward in the specified period. Study Design: Prospective, Observational Study Sample Size With Justification: 62 cases. Study Duration: From JANUARY 2018 to NOVEMBER 2019. Inclusion Criteria: Study to be conducted in 62 patients with Spirometry confirmed COPD according to GOLD guidelines, age greater than 40 years and admitted with AECOPD in the emergency or ward in the specified period. Exclusion Criteria: Patients with the below mentioned are all excluded from the study - Acute coronary syndrome, post CPR. post cardiac surgery, persistent hemodynamic instability, acute aortic dissection, pulmonary embolism, primary lung diseases other than COPD, patient already on NIV, marked renal failure, severe anaemia, sepsis ,stroke. Study Methodology: The study design is prospective, observational and non-interventional. Study to be conducted in patients with spirometry proven COPD according to GOLD guidelines admitted with AECOPD in the emergency, ward, HDU, MDCCU in the specified period. Detailed medical history along with smoking history, comorbidities and medication history noted, general and respiratory examination to be done for every patient at the time of admission.SpO2 under room air, O2 requirement, ABG values, CXR, Hemogram values, creatinine levels, ECG findings, ECHO findings at the time of admission to be noted. Blood sample to be taken to analyse serum cTnI levels along with routine investigations with informed consent from each patient at initial point of care. Cardiac Troponin I to be estimated by immunochromatographic qualitative assay, DIAQUICK Troponin I cassette. The DIAQUICK Troponin I Cassette is an immunochromatographic assay. The minimum detection level is 1.0 ng/ml with Sensitivity 95%, Specificity 97% and Accuracy 90%. Whether the patient was admitted in ward or ICU, whether the patient required any ventilatory support (NIV or invasive ventilation), duration of the stay in the hospital was all followed up. The end point of the follow up is discharge or death. Results: Out of the 62 patients, 7(11.3%) patients were tested to be Troponin I positive during exacerbation. These patients had longer duration of COPD, increased presence of Pulmonary hypertension, Lower Spo2 on room air and higher PaCo2 at presentation, increased requirement of ventilatory support with ICU care and more duration of hospitalization.

Keywords

• chronic obstructive pulmonary disease
• exacerbation
• troponin