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 multicentre 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 (interquartile range 2.5–6.6 ng·L−1), with levels above the 99th percentile reference limit of 27 ng·L−1 observed in 1.8% of patients. In Cox regression analyses including adjustments for airflow limitation, dyspnoea 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 (hazard ratio (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. High-sensitivity troponin I is a strong predictor of all-cause mortality in patients with stable COPD independent from established mortality predictors of COPD and irrespective of their cardiovascular risk profile http://bit.ly/352ZtDw

中文翻译：

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稳定期 COPD 患者的高敏肌钙蛋白 I 和全因死亡率：COSYCONET 研究分析

慢性阻塞性肺疾病 (COPD) 是导致死亡的主要原因，相当一部分人口死于心血管疾病。高敏肌钙蛋白 I (hs-TnI) 可能有助于更好地识别具有高死亡风险的 COPD 患者。我们旨在研究 hs-TnI 对除已建立的 COPD 评估之外的全因死亡率的预测价值，并在考虑相关心血管危险因素和普遍的心血管疾病后，在稳定的 COPD 广泛人群中进行研究。在参与多中心 COSYCONET 队列研究的所有严重程度阶段的 2085 名稳定期 COPD 患者中，评估了循环 hs-TnI 浓度以及广泛的呼吸和心血管标志物。主要结果是 3 年随访期间的全因死亡率。2020 年可检测到 Hs-TnI (96. 9%) 患者。中值 hs-TnI 浓度为 3.8 ng·L-1（四分位距 2.5-6.6 ng·L-1），在 1.8% 的患者中观察到的水平高于 27 ng·L-1 的第 99 个百分位参考限值。在 Cox 回归分析中，包括对气流受限、呼吸困难等级、运动能力和严重急性加重史的调整，以及传统的心血管危险因素、估计的肾小球滤过率、踝肱指数、N 端脑钠肽前体和心血管疾病患病率疾病，hs-TnI 是全因死亡率的重要预测因子，既作为连续变量（log hs-TnI 的风险比（HR）为 1.28，95% CI 1.01–1.62），也根据截止值 6 进行分类ng·L−1（HR 1.63，95% CI 1.10–2.42）。对于稳定期 COPD 患者，hs-TnI 是一种强有力的全因死亡率预测指标，超越了既定的 COPD 死亡率预测指标，并且独立于广泛的心血管危险因素和流行的心血管疾病。将远低于参考上限的 Hs-TnI 浓度添加到既定的风险评估中时，可为所有 COPD 患者提供进一步的预后价值。高敏肌钙蛋白 I 是稳定型 COPD 患者全因死亡率的强预测因子，独立于已确定的 COPD 死亡率预测因子，且与他们的心血管风险状况无关 http://bit.ly/352ZtDw 将远低于参考上限的 Hs-TnI 浓度添加到既定的风险评估中时，可为所有 COPD 患者提供进一步的预后价值。高敏肌钙蛋白 I 是稳定型 COPD 患者全因死亡率的强预测因子，独立于已确定的 COPD 死亡率预测因子，且与他们的心血管风险状况无关 http://bit.ly/352ZtDw 将远低于参考上限的 Hs-TnI 浓度添加到既定的风险评估中时，可为所有 COPD 患者提供进一步的预后价值。高敏肌钙蛋白 I 是稳定型 COPD 患者全因死亡率的强预测因子，独立于已确定的 COPD 死亡率预测因子，且与他们的心血管风险状况无关 http://bit.ly/352ZtDw