Prognostic value of cardiac-specific troponins in chronic obstructive pulmonary disease exacerbations: a systematic...

fer useful prognostic information in this population and might identify a group of patients to target for more intensive thera- peutic interventions.

Cardiac troponins are specific and sensitive biomarkers used for diagnosis and prognosis in myocardial infarction. Troponin elevations can also occur in other disorders and may be useful to predict mortality. This systematic review is intended to determine whether or not elevated troponins are predictive of mortality (in-hospital, short term, and longer-term) among patients admitted with COPD exacerbation.

PubMed/Medline was searched to identify relevant English language articles that measured troponin T or troponin I in patients hospitalized for COPD exacerbation and assessed mortality, with or without other clinical outcomes. Only studies of significant size that presented original data were included.

Nine research reports (4 prospective, 5 retrospective) qualified for review. Mortality was consistently increased in seven of these studies among COPD patients who had elevated troponin levels during an exacerbation. One retrospective study found no effect on (in-hospital) mortality but reported increased morbidity (greater oxygen requirements and more ventilatory failure) and increased length of hospital stay in patients with elevated troponin whereas discharge troponin T in one prospective study predicted hospitalizations.

The review shows a strong direct association between cardiac troponin and mortality in patients hospitalized for COPD exacerbations. Troponin monitoring could offer useful prognostic information in this population and might identify a group of patients to target for more intensive therapeutics interventions.