Enhancing personalised care in COPD exacerbation: the role of cardiac/inflammatory biomarkers
Introduction: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide.1 Many patients with acute COPD exacerbations (AECOPD) need intensive care. The relationship between COPD and cardiovascular diseases (CVD) is well established, with many studies confirming com...
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Elsevier
2025-07-01
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| Series: | Clinical Medicine |
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| author | Pouria Khashayar Kenneth Spearpoint Patricia Khashayar Manivannan Srinivasan Thida Win |
| author_facet | Pouria Khashayar Kenneth Spearpoint Patricia Khashayar Manivannan Srinivasan Thida Win |
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| description | Introduction: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide.1 Many patients with acute COPD exacerbations (AECOPD) need intensive care. The relationship between COPD and cardiovascular diseases (CVD) is well established, with many studies confirming comorbidities, such as coronary artery disease, heart failure and diabetes mellitus, to significantly impact their prognosis.2,3 Thus, the role of cardiac dysfunction in increasing the mortality rate (between 30% and 60%) in COPD individuals is well documented and known to be closely linked to advancing age as well as long-term disabilities and, therefore, is a tremendous burden on society.4 Materials and Methods: A systematic literature review in PubMed and Web of Science using keywords including ‘Exacerbated COPD’, cardiovascular events such as ‘cardiovascular mortality’, ‘coronary heart disease’, ‘CVD’, ‘myocardial ischemia’ and ‘heart failure’ and cardiac/inflammatory biomarkers (‘Troponin’, ‘B-Type Natriuretic Peptide (BNP)’ and ‘C-Reactive Protein (CRP)’) was undertaken to help provide a better picture of this association. Results and Discussion: Troponin T is one of the optimal cardiac biomarkers, known for its crucial role in muscle contraction. It has gained even more attention in recent years because of its potential role in detecting subclinical CVD in AECOPD patients.5 In other words, elevated troponin levels (>14 ng/L) have been linked with a significantly higher risk of underlying ischaemic heart disease (IHD) (up to 70%) and subsequently experiencing a major adverse CVD event (up to 23.1%) within the next 90 days. Additionally, these patients have a higher mortality risk (up to 50%) compared with their counterparts with no elevated levels.NT-proBNP is another cardiac-specific biomarker that has been linked with poor prognosis in COPD patients. Existing literature suggests that elevated BNP levels (>100 pg/mL) can increase the risk of all-cause mortality (up to 22%) within 2 years among AECOPD patients.6 Additionally, a notably heightened risk of CVD events within the first 30 days following a hospitalisation for an exacerbation is reported in COPD patients with elevated BNP.High levels of the inflammatory biomarker CRP have been related with poor prognosis in COPD patients.7 Several studies have demonstrated COPD patients with CRP levels ≥8 mg/L have approximately threefold increased risk of all-cause mortality. Moreover, CRP levels are also considered a strong predictive factor of future CVD events and 1-year mortality in COPD patients with multiple exacerbations.8 Conclusion: These findings suggest that incorporation of cardiac and inflammatory biomarkers into the management of COPD exacerbations has the potential to significantly improve the prognosis and outcome of patients through providing better patient stratification guidance.8,9 In other words, such stratifications can help guide clinicians with targeted interventions, such as initiating or adjusting pharmacological therapy, optimising pulmonary rehabilitation programmes and, thus, providing appropriate and personalised cardiovascular care. Early identification of high-risk patients can lead to better disease management, potentially improving survival rates, reducing hospital stays and re-admission rates, and thereby lowering the combined burden of these conditions. |
| format | Article |
| id | doaj-art-effa4d74cc394403a88adbdc7228f03d |
| institution | DOAJ |
| issn | 1470-2118 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
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| series | Clinical Medicine |
| spelling | doaj-art-effa4d74cc394403a88adbdc7228f03d2025-08-20T02:47:21ZengElsevierClinical Medicine1470-21182025-07-0125410039310.1016/j.clinme.2025.100393Enhancing personalised care in COPD exacerbation: the role of cardiac/inflammatory biomarkersPouria Khashayar0Kenneth Spearpoint1Patricia Khashayar2Manivannan Srinivasan3Thida Win4University of HertfordshireHammersmith HospitalInternational Institute for BiosensingEast and North Hertfordshire NHS TrustEast and North Hertfordshire NHS TrustIntroduction: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide.1 Many patients with acute COPD exacerbations (AECOPD) need intensive care. The relationship between COPD and cardiovascular diseases (CVD) is well established, with many studies confirming comorbidities, such as coronary artery disease, heart failure and diabetes mellitus, to significantly impact their prognosis.2,3 Thus, the role of cardiac dysfunction in increasing the mortality rate (between 30% and 60%) in COPD individuals is well documented and known to be closely linked to advancing age as well as long-term disabilities and, therefore, is a tremendous burden on society.4 Materials and Methods: A systematic literature review in PubMed and Web of Science using keywords including ‘Exacerbated COPD’, cardiovascular events such as ‘cardiovascular mortality’, ‘coronary heart disease’, ‘CVD’, ‘myocardial ischemia’ and ‘heart failure’ and cardiac/inflammatory biomarkers (‘Troponin’, ‘B-Type Natriuretic Peptide (BNP)’ and ‘C-Reactive Protein (CRP)’) was undertaken to help provide a better picture of this association. Results and Discussion: Troponin T is one of the optimal cardiac biomarkers, known for its crucial role in muscle contraction. It has gained even more attention in recent years because of its potential role in detecting subclinical CVD in AECOPD patients.5 In other words, elevated troponin levels (>14 ng/L) have been linked with a significantly higher risk of underlying ischaemic heart disease (IHD) (up to 70%) and subsequently experiencing a major adverse CVD event (up to 23.1%) within the next 90 days. Additionally, these patients have a higher mortality risk (up to 50%) compared with their counterparts with no elevated levels.NT-proBNP is another cardiac-specific biomarker that has been linked with poor prognosis in COPD patients. Existing literature suggests that elevated BNP levels (>100 pg/mL) can increase the risk of all-cause mortality (up to 22%) within 2 years among AECOPD patients.6 Additionally, a notably heightened risk of CVD events within the first 30 days following a hospitalisation for an exacerbation is reported in COPD patients with elevated BNP.High levels of the inflammatory biomarker CRP have been related with poor prognosis in COPD patients.7 Several studies have demonstrated COPD patients with CRP levels ≥8 mg/L have approximately threefold increased risk of all-cause mortality. Moreover, CRP levels are also considered a strong predictive factor of future CVD events and 1-year mortality in COPD patients with multiple exacerbations.8 Conclusion: These findings suggest that incorporation of cardiac and inflammatory biomarkers into the management of COPD exacerbations has the potential to significantly improve the prognosis and outcome of patients through providing better patient stratification guidance.8,9 In other words, such stratifications can help guide clinicians with targeted interventions, such as initiating or adjusting pharmacological therapy, optimising pulmonary rehabilitation programmes and, thus, providing appropriate and personalised cardiovascular care. Early identification of high-risk patients can lead to better disease management, potentially improving survival rates, reducing hospital stays and re-admission rates, and thereby lowering the combined burden of these conditions.http://www.sciencedirect.com/science/article/pii/S1470211825001113 |
| spellingShingle | Pouria Khashayar Kenneth Spearpoint Patricia Khashayar Manivannan Srinivasan Thida Win Enhancing personalised care in COPD exacerbation: the role of cardiac/inflammatory biomarkers Clinical Medicine |
| title | Enhancing personalised care in COPD exacerbation: the role of cardiac/inflammatory biomarkers |
| title_full | Enhancing personalised care in COPD exacerbation: the role of cardiac/inflammatory biomarkers |
| title_fullStr | Enhancing personalised care in COPD exacerbation: the role of cardiac/inflammatory biomarkers |
| title_full_unstemmed | Enhancing personalised care in COPD exacerbation: the role of cardiac/inflammatory biomarkers |
| title_short | Enhancing personalised care in COPD exacerbation: the role of cardiac/inflammatory biomarkers |
| title_sort | enhancing personalised care in copd exacerbation the role of cardiac inflammatory biomarkers |
| url | http://www.sciencedirect.com/science/article/pii/S1470211825001113 |
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