Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of death with a considerable part of the population dying from cardiovascular diseases. High-sensitivity troponin I (hs-TnI) might help to better identify COPD patients at high risk of mortality. We aimed to study the predictive value of hs-TnI for all-cause mortality beyond established COPD assessments, and after consideration of relevant cardiovascular risk factors and prevalent cardiovascular diseases, in a broad population with stable COPD.
Circulating hs-TnI concentrations together with a wide range of respiratory and cardiovascular markers were evaluated in 2085 patients with stable COPD across all severity stages enrolled in the multi-center COSYCONET cohort study. The primary outcome was all-cause mortality over 3 years of follow-up.
Hs-TnI was detectable in 2020 (96.9%) patients. The median hs-TnI concentration was 3.8 ng·L−1 (IQR, 2.5‒6.6 ng·L−1) with levels above the 99th percentile reference limit of 27 ng·L−1 observed in 1.8% patients. In Cox regression analyses including adjustments for airflow limitation, dyspnea grade, exercise capacity, and history of severe exacerbations, as well as traditional cardiovascular risk factors, estimated glomerular filtration rate, ankle-brachial index, N-terminal pro-brain natriuretic peptides, and prevalent cardiovascular diseases, hs-TnI was a significant predictor for all-cause mortality, both as a continuous variable (HR for log hs-TnI, 1.28 [95%CI, 1.01‒1.62]) and categorised according to the cut-off of 6 ng·L−1 (HR, 1.63 [95%CI, 1.10‒2.42]).
In patients with stable COPD, hs-TnI is a strong predictor of all-cause mortality beyond established COPD mortality predictors, and independent of a broad range of cardiovascular risk factors and prevalent cardiovascular diseases. Hs-TnI concentrations well-below the upper reference limit provide further prognostic value for all patients with COPD when added to established risk assessments.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dr. Waschki has nothing to disclose.
Conflict of interest: Dr. Alter reports grants from German Federal Ministry of Education and Research (BMBF) Competence Network Asthma and COPD (ASCONET), grants from AstraZeneca GmbH, grants and non-financial support from Bayer Schering Pharma AG, grants, personal fees and non-financial support from Boehringer Ingelheim Pharma GmbH & Co. KG, grants and non-financial support from Chiesi GmbH, grants from GlaxoSmithKline, grants from Grifols Deutschland GmbH, grants from MSD Sharp & Dohme GmbH, grants and personal fees from Mundipharma GmbH, grants, personal fees and non-financial support from Novartis Deutschland GmbH, grants from Pfizer Pharma GmbH, grants from Takeda Pharma Vertrieb GmbH & Co. KG, outside the submitted work.Dr. Alter reports grants from German Federal Ministry of Education and Research (BMBF) Competence Network Asthma and COPD (ASCONET), grants from AstraZeneca GmbH, grants and non-financial support from Bayer Schering Pharma AG, grants, personal fees and non-financial support from Boehringer Ingelheim Pharma GmbH & Co. KG, grants and non-financial support from Chiesi GmbH, grants from GlaxoSmithKline, grants from Grifols Deutschland GmbH, grants from MSD Sharp & Dohme GmbH, grants and personal fees from Mundipharma GmbH, grants, personal fees and non-financial support from Novartis Deutschland GmbH, grants from Pfizer Pharma GmbH, grants from Takeda Pharma Vertrieb GmbH & Co. KG, outside the submitted work.
Conflict of interest: Dr. Zeller has nothing to disclose.
Conflict of interest: Dr. Magnussen has nothing to disclose.
Conflict of interest: Dr. Neumann reports personal fees from Abbott Diagnostics, personal fees from Siemens, outside the submitted work.
Conflict of interest: Dr. Twerenbold reports grants from Swiss National Science Foundation (Grant No P300PB_167803), grants from Swiss Heart Foundation, grants from Swiss Society of Cardiology, grants from Cardiovascular Research Foundation Basel, personal fees from Abbott Diagnostics, personal fees from Amgen, personal fees from Roche Diagnostics, personal fees from Siemens, personal fees from Singulex, personal fees from BRAHMS, outside the submitted work.
Conflict of interest: Dr. Sinning has nothing to disclose.
Conflict of interest: Dr. Herr has nothing to disclose.
Conflict of interest: Dr. Kahnert has nothing to disclose
Conflict of interest: Dr. Fähndrich has nothing to disclose.
Conflict of interest: Dr. Blankenberg reports personal fees from Abbott Diagnostics, personal fees from Siemens, personal fees from Thermo Fisher, personal fees from Singulex outside the submitted work.
Conflict of interest: Dr. Rabe has nothing to disclose.
Conflict of interest: Dr. Welte reports personal fees from AstraZeneca, Boehringer, Berlin Chemie, Chiesi, GSK, Novartis, grants from AstraZeneca, Novartis, outside the submitted work.
Conflict of interest: Dr. Jörres has nothing to disclose.
Conflict of interest: Dr. Vogelmeier reports grants and personal fees from AstraZeneca, grants and personal fees from Boehringer Ingelheim, personal fees from CSL Behring, personal fees from Chiesi, grants and personal fees from GlaxoSmithKline, grants and personal fees from Grifols, personal fees from Menarini, personal fees from Mundipharma, grants and personal fees from Novartis, personal fees from Teva, personal fees from Cipla, grants from Bayer-Schering, grants from MSD, grants from Pfizer, outside the submitted work.
Conflict of interest: Dr. Bals reports grants and personal fees from AstraZeneca, grants and personal fees from Boehringer Ingelheim, personal fees from GlaxoSmithKline, personal fees from Grifols, grants and personal fees from Novartis, personal fees from CSL Behring, grants from German Federal Ministry of Education and Research (BMBF) Competence Network Asthma and COPD (ASCONET), grants from Sander Stiftung, grants from Schwiete Stiftung, grants from Krebshilfe, grants from Mukoviszidose eV, outside the submitted work.
Conflict of interest: Dr. Watz reports personal fees from AstraZeneca, personal fees from Boehringer Ingelheim, personal fees from GlaxoSmithKline, personal fees from BerlinChemie, personal fees from Chiesi, personal fees from Novartis , personal fees from Roche, outside the submitted work.
- Received July 3, 2019.
- Accepted November 11, 2019.
- Copyright ©ERS 2019
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