Is elevated troponin associated with in-hospital mortality in emergency department patients admitted with chronic obstructive pulmonary disease?

The aim of this study was to determine the prevalence and prognostic value of troponin elevation at emergency department (ED) presentation in patients admitted with an exacerbation of chronic obstructive pulmonary disease (COPD). A retrospective cohort study of ED patients with acute exacerbations of COPD who were admitted to hospital and in whom troponin was assayed at ED presentation. Other data collected included demographics, clinical characteristics, test results, and outcome. Outcome of interest was in-hospital mortality. A total of 252 patients were studied, median age 73 years, 61% men. In-hospital mortality was 4.4% [n=11; 95% confidence interval (CI) 2.5-7.7%]. Seventy-eight patients had elevated troponin of greater than 99th centile (31%, 95% CI 26-37%). Factors independently associated with mortality were troponin elevation [odds ratio (OR) 8.3, 95% CI 1.58-43.7], pH less than 7.2 (OR 12.7, 95% CI 1.86-86.4), and requirement for noninvasive ventilation (OR 8.09, 95% CI 1.61-40.8). In conclusion, troponin elevation is associated with increased in-hospital mortality in ED patients with acute exacerbation of COPD.