Serum Troponin-I as a prognostic marker in acute exacerbated chronic obstructive pulmonary disease patients

Background: Chronic Obstructive Pulmonary Disease [COPD] is a major cause of chronic morbidity and mortality worldwide. It is the fifth leading cause of death worldwide. The spectrum of cardiovascular complications associated with COPD is clearly broad, right ventricular [RV] dysfunction and pulmonary vascular disease are common in COPD and progress with time. In RV failure, cardiac Troponins [cTn] are suspected to be elevated secondary to RV ischemia or micro infarction

Objective: To evaluate the prognostic value of cardiac Troponin I level in acute exacerbated chronic obstructive pulmonary diseases [AECOPD] and its impact on the hospital outcome in those patients

Patients and methods: This study was performed on 60 patients with AECOPD, admitted at Chest Department and respiratory ICU; Zagazig University hospital. All patients were subjected to: thorough history taking, clinical examination, electrocardiography and echocardiography, arterial blood gas [ABG] analysis, measure forced vital capacity [FVC] and forced expiratory volume in first second [FEV1], serum assay of cTnI level which is considered -ve if <0.01 ng/ml and +ve if >/=0.01 ng/ml

Results: cTnI was positive in 42 AECOPD patients. cTnI positivity was more prominent among patients with very severe exacerbation of COPD and in those with past history of LTOT, MV, ICU admission. Also, cTnI positivity was more in patients admitted to ICU rather than those managed in the ward and among patients who needed MV rather than who did not need it and in patients who failed weaned rather that who succeeded weaned. P-pulmonate, Rt. ventricular strain, high pulmonary artery pressure, hypoxemia and hypercapnia showed a great effect upon cTnI positivity. The duration of hospitalization was longer among cTnI +ve patients than cTnI ?ve ones, Tropinin cutoff value for the prediction of death was >0.055 ng/ml with Sensitivity = 75%, Specificity = 68%

Conclusion: Positive cTnI in AECOPD patients may suggest exacerbation severity and the occurrence of pulmonary hypertension and right ventricular dysfunction. Positive cTnI is considered as good prognostic marker for the possibility of a need for MV and a longer duration of hospitalization. MV may further elevate cTnI in AECOPD patients and with possible weaning failure. Negative cTnI and cTnI

Patterns of admitted cases to respiratory intensive care unit at Zagazig University Hospitals, Egypt

Background: It is well accepted that early appropriate referral of patients to an ICU can significantly reduce early and possibly late mortality in the critically ill. At the same time improper selection of patients for ICU, often limits bed availability in ICUs. This in turn, adversely affects the dynamics of the whole hospital

Objective: To determine the admission pattern and outcome of patients in the Respiratory Intensive Care Unit [RICU] of Zagazig University Hospitals, Egypt. Design. The study was carried out as a prospective analytical study

Patients and methods: All cases admitted to RICU during the period from March 2010 to October 2010. They were 200 cases [126 males [63%] and 74 females [37%]] with an age range from 11 to 86 years. They were classified according to the causes of admission to RICU into 162 cases due to primary respiratory causes [81%] and 38 cases due to secondary respiratory causes [19%]. On admission the following were carried out for all patients: full medical history, chest examination, assessment of Glasgow Coma Scale [GCS] and Acute Physiology and Chronic Health Evaluation II [APHCHE II] score, arterial blood gases analysis, plain chest and heart X-ray, computerized tomography [CT] electrocardiography [ECG] or echocardiography [ECHO] study when needed and assessment of the outcome

Results: Two hundred cases were admitted during the study period: 57% were referred by chest physicians, 14.5% from other hospitals, 13.5% from other departments and others from chest ward and emergency room [ER]. The mean GCS and APHACHE II score were 12.7 +/- 3.97 and 14.4 +/- 6.5 respectively. The length of stay in RICU was 7.2 +/- 7.4 days. Analysis of outcome of the cases showed that 70 patients [35%] were transferred to chest ward, 61patients [30.5%] died and 54 patients [27.0%] were discharged to home. There was a significant difference between cases with primary [1[ry]] and secondary [2[ry]] respiratory causes regarding outcome [P < 0.005] with mortality rate [26.6%] among cases with 1[ry] respiratory causes while in cases with 2[ry] respiratory causes were 60.4%. Outcome as regards source of admission showed that the highest percentage of death occurred among cases referred from chest ward and non chest physicians [63.7% and 62.5%] respectively. There was a significant association between outcome and duration of stay [P < 0.001]. Concerning the outcome on using mechanical ventilation, the mortality rate in mechanically ventilated patients was 52.05% while in non mechanically ventilated patients it was 47.5%

Conclusion: This study showed that the best prognosis of admitted patients to RICU was for those who were transferred earlier especially those transferred by chest physicians and patients with 1[ry] respiratory diseases than those with 2[ry] respiratory diseases. Also, cases with high Glasgow Coma Scale and low APACH II score and those with a short duration of stay in RICU, especially without the need for mechanical ventilation had a good prognosis. Therefore, considering those aspects in the clinical practice would be reflected as a better outcome on dealing with RICU patients