The Importance of Measuring Troponin in Chronic Obstructive Pulmonary Disease Exacerbations: A Systematic Review

Elmenawi, Khaled A; Anil, Vishwanath; Gosal, Harpreet; Kaur, Harsimran; Ngassa, Hyginus Chakwop; Mohammed, Lubna

doi:10.7759/cureus.17451

Cited by 3 publications

(5 citation statements)

References 23 publications

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“…Of the 141 unique molecular features in the SGTCCA-Net network, 89 of them are significantly associated with FEV 1 (FDR < 0.05), while of 88 unique molecular features in the SmCCNet network, only 14 of them are significantly associated with FEV1 (FDR < 0.05). In particular, Troponin T ( ρ = −0.278, p < 10 −3 ) and C-reactive protein ( ρ = −0.190, p < 10 −3 ) have a strong correlation with respect to FEV1 and are not identified by SmCCNet, and studies have shown that elevated Troponin T levels during exacerbation are associated with death in patients with COPD [52, 53], and more validation will need to be conducted to evaluate whether it is related to FEV 1 at the stable state.…”

Section: Resultsmentioning

confidence: 99%

A Generalized Higher-order Correlation Analysis Framework for Multi-Omics Network Inference

Liu,

Pratte,

Castaldi

et al. 2024

Preprint

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Multiple -omics (genomics, proteomics, etc.) profiles are commonly generated to gain insight into a disease or physiological system. Constructing multi-omics networks with respect to the trait(s) of interest provides an opportunity to understand relationships between molecular features but integration is challenging due to multiple data sets with high dimensionality. One approach is to use canonical correlation to integrate one or two omics types and a single trait of interest. However, these types of methods may be limited due to (1) not accounting for higher-order correlations existing among features, (2) computational inefficiency when extending to more than two omics data when using a penalty term-based sparsity method, and (3) lack of flexibility for focusing on specific correlations (e.g., omics-to-phenotype correlation versus omics-to-omics correlations). In this work, we have developed a novel multi-omics network analysis pipeline called Sparse Generalized Tensor Canonical Correlation Analysis Network Inference (SGTCCA-Net) that can effectively overcome these limitations. We also introduce an implementation to improve the summarization of networks for downstream analyses. Simulation and real-data experiments demonstrate the effectiveness of our novel method for inferring omics networks and features of interest.

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Section: Resultsmentioning

confidence: 99%

A Generalized Higher-order Correlation Analysis Framework for Multi-Omics Network Inference

Liu,

Pratte,

Castaldi

et al. 2024

Preprint

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“…Instead, it is noted that the cause of the elevated troponin in these populations is unclear, with studies suggesting that the elevated troponin may often be a result of systemic inflammation-induced myocardial injury. 5,21,22 We are aware that the effect of troponin on time to MACE events within 90 days might be modified by interventions that might lead to better treatment and prevention of future MACE events. One intervention that we would have liked to have included as an effect modifier is coronary angiography but did not have sufficient power to do so.…”

Section: Discussionmentioning

confidence: 99%

“…However, there is an accumulating body of evidence suggesting that hsTrop elevation is always associated with an adverse outcome. 5,21 For example, hsTrop levels in 20,000 consecutive hospital patients, most of whom had no suspicion of an acute CV event, was associated with 1-year mortality. 11 Similarly, hsTrop levels were associated with outcomes in emergency room and intensive care patients.…”

Section: Discussionmentioning

confidence: 99%

“…4 Whilst troponin is almost universally measured in patients presenting to hospital with symptoms of acute COPD exacerbation, interpretation of an elevated high sensitivity troponin (hsTrop) is challenging in this context, given the possibility that the result may reflect myocardial injury, Type 2 or Type 1 MI. 5 The clinical implications of an elevated hsTrop are therefore currently unclear, especially given that 20% of hospital inpatients have hsTrop levels above the upper limit of normal. 6 Previous studies have suggested that exacerbations are associated with elevated troponin levels and that COPD patients with elevated troponin levels of ≥0.04 μg•L −1 at exacerbation are at increased risk of death post hospital discharge.…”

Section: Introductionmentioning

confidence: 99%

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The Relationship Between Cardiac Troponin in People Hospitalised for Exacerbation of COPD and Major Adverse Cardiac Events (MACE) and COPD Readmissions

Kallis,

Kaura,

Samuel

et al. 2023

COPD

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Background: No single biomarker currently risk stratifies chronic obstructive pulmonary disease (COPD) patients at the time of an exacerbation, though previous studies have suggested that patients with elevated troponin at exacerbation have worse outcomes. This study evaluated the relationship between peak cardiac troponin and subsequent major adverse cardiac events (MACE) including allcause mortality and COPD hospital readmission, among patients admitted with COPD exacerbation. Methods: Data from five cross-regional hospitals in England were analysed using the National Institute of Health Research Health Informatics Collaborative (NIHR-HIC) acute coronary syndrome database (2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017). People hospitalised with a COPD exacerbation were included, and peak troponin levels were standardised relative to the 99th percentile (upper limit of normal). We used Cox Proportional Hazard models adjusting for age, sex, laboratory results and clinical risk factors, and implemented logarithmic transformation (base-10 logarithm). The primary outcome was risk of MACE within 90 days from peak troponin measurement. Secondary outcome was risk of COPD readmission within 90 days from peak troponin measurement. Results: There were 2487 patients included. Of these, 377 (15.2%) patients had a MACE event and 203 (8.2%) were readmitted within 90 days from peak troponin measurement. A total of 1107 (44.5%) patients had an elevated troponin level. Of 1107 patients with elevated troponin at exacerbation, 256 (22.8%) had a MACE event and 101 (9.0%) a COPD readmission within 90 days from peak troponin measurement. Patients with troponin above the upper limit of normal had a higher risk of MACE (adjusted HR 2.20, 95% CI 1.75-2.77) and COPD hospital readmission (adjusted HR 1.37, 95% CI 1.02-1.83) when compared with patients without elevated troponin. Conclusion: An elevated troponin level at the time of COPD exacerbation may be a useful tool for predicting MACE in COPD patients. The relationship between degree of troponin elevation and risk of future events is complex and requires further investigation.

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“…Increased CRP levels may indicate bacterial pneumonia, especially if associated with a high white blood cell count [ 119 ]. An increased troponin level can be observed in patients with COPD and can increase further during AECOPD [ 120 ], but myocardial ischemia should be strongly suspected when associated with an abnormal ECG and symptoms related to cardiac dysfunction [ 121 ].…”

Section: Differential Diagnosis and Paired Diagnosismentioning

confidence: 99%

Implementation of the Care Bundle for the Management of Chronic Obstructive Pulmonary Disease with/without Heart Failure

Bianco,

Canepa,

Catapano

et al. 2024

JCM

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Chronic obstructive pulmonary disease (COPD) is often part of a more complex cardiopulmonary disease, especially in older patients. The differential diagnosis of the acute exacerbation of COPD and/or heart failure (HF) in emergency settings is challenging due to their frequent coexistence and symptom overlap. Both conditions have a detrimental impact on each other’s prognosis, leading to increased mortality rates. The timely diagnosis and treatment of COPD and coexisting factors like left ventricular overload or HF in inpatient and outpatient care can improve prognosis, quality of life, and long-term outcomes, helping to avoid exacerbations and hospitalization, which increase future exacerbation risk. This work aims to address existing gaps, providing management recommendations for COPD with/without HF, particularly when both conditions coexist. During virtual meetings, a panel of experts (the authors) discussed and reached a consensus on the differential and paired diagnosis of COPD and HF, providing suggestions for risk stratification, accurate diagnosis, and appropriate therapy for inpatients and outpatients. They emphasize that when COPD and HF are concomitant, both conditions should receive adequate treatment and that recommended HF treatments are not contraindicated in COPD and have favorable effects. Accurate diagnosis and therapy is crucial for effective treatment, reducing hospital readmissions and associated costs. The management considerations discussed in this study can potentially be extended to address other cardiopulmonary challenges frequently encountered by COPD patients.

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The Importance of Measuring Troponin in Chronic Obstructive Pulmonary Disease Exacerbations: A Systematic Review

Cited by 3 publications

References 23 publications

A Generalized Higher-order Correlation Analysis Framework for Multi-Omics Network Inference

A Generalized Higher-order Correlation Analysis Framework for Multi-Omics Network Inference

The Relationship Between Cardiac Troponin in People Hospitalised for Exacerbation of COPD and Major Adverse Cardiac Events (MACE) and COPD Readmissions

Implementation of the Care Bundle for the Management of Chronic Obstructive Pulmonary Disease with/without Heart Failure

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