Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 20953

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : January | Volume : 17 | Issue : 1 | Page : OC39 - OC42 Full Version

Cardiac Troponin I Levels in Acute Exacerbation of COPD Patients: A Cross-sectional Study

Published: January 1, 2023 | DOI:
Anand Koppad, Geeta C Chintamani, G Krupahree, Sushma Shetty

1. Associate Professor, Department of General Medicine, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India. 2. Senior Resident, Department of General Medicine, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India. 3. Senior Resident, Department of General Medicine, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India. 4. Senior Resident, Department of General Medicine, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India.

Correspondence Address :
Geeta C Chintamani,
Chetana Hostel, Kims Campus, Hubli, Karnataka, India.


Introduction: Chronic Obstructive Pulmonary Disease (COPD) is associated with right ventricular overloading and pulmonary hypertension. In COPD patients co-morbidities determine the outcome and quality of life. Cardiac Troponins (cTn) are suspected to be elevated in right ventricular failure.

Aim: To find the incidence of cardiac Troponin-I levels and association of elevated cTnI levels with clinical outcome in acute exacerbation of COPD.

Materials and Methods: The cross-sectional study comprised of 102 patients with acute exacerbation of COPD. These patients were admitted in medical wards and Intensive Care Unit (ICU) in the Department of General Medicine, Karnataka Institute of Medical Sciences Hospital, Hubli, Karnataka, India, from 2018-2020. Investigations included complete blood count, renal function tests, serum electrolytes, liver function tests, Electrocardiography (ECG), ECHO and chest X-ray. Association of cardiac troponin I and acute exacerbation of COPD was evaluated. The cTnI level ≥0.01ng/mL was considered positive.

Results: The serum cTnI was found to be positive in 43 (42.2%) patients with acute exacerbation of COPD. The patients with cTnI levels ≥0.01 ng/mL had significantly higher need for Non Invasive Ventilation (NIV) 32 (74.4%), invasive ventilation support 5 (11.6%), prolonged duration of hospital stay 33 (76.7%), and higher mortality 15 (34.9%) rate as compared to patients having cTnI <0.01 ng/mL.

Conclusion: The cTnI is elevated in a significant subset of patients with acute exacerbation of COPD. cTnI elevation was associated with higher need for NIV and invasive ventilator support. Levels of cTnI ≥0.01 ng/mL may be considered as a biomarker to predict morbidity and mortality in acute exacerbation of COPD patients.


Chronic obstructive pulmonary disease, Non invasive ventilation, Invasive ventilation support, Pulmonary hypertension

Chronic Obstructive Pulmonary Disease (COPD) is characterised by a poorly reversible limitation in airflow, and corresponds to the major cause of chronic respiratory insufficiency and cor pulmonale (1). COPD as a systemic disease causes structural and functional changes in lung and in many organs (1). It is a chronic inflammatory disease with extra pulmonary manifestations like cardiovascular diseases, osteoporosis, lung cancer, diabetes, metabolic syndrome, and depression.

Acute Exacerbations of COPD (AECOPD) is defined as “an event in the natural course of the disease characterised by a change in the patient’s baseline dyspnea, cough, and/or sputum that is beyond normal day-to-day variations, is acute in onset, and may warrant a change in regular medication in a patient with underlying COPD” (1).

AECOPD accounts for substantial morbidity and mortality, attributed to COPD (2). These impair quality of life and also cause permanent loss of lung function. Hospitalisations due to COPD exacerbations are a major economic burden (3),(4).

Cardiovascular risk factors and cardiac co-morbidity are more in patients with COPD. It reflects the severity of the exacerbation. COPD patients with elevated troponins have reduced saturations, ABG showing more acidotic and more hypercapnoeic (5).

In AECOPD, damage to the cardiac myocyte and cardiac injury occurs. Right ventricular (RV) dysfunction and pulmonary vascular disease are common and progressing in nature (4). Loss of cell membrane integrity releases of free cytoplasm troponin-I into the circulation followed by release of structurally bound troponin resulting in sustained elevation (6).

The cTnI elevation has been attributed to increased work of breathing, increased left ventricular afterload because of more negative intrathoracic pressure, worsening of pulmonary hypertension, hypoxaemia and hypercapnoea (7). This study aimed to evaluate the prognostic value of Troponin I level, and its impact on the hospital outcome in patients with AECOPD.

Material and Methods

It was a single centre cross-sectional study, conducted on patients admitted in the Department of General Medicine, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India, from 1st November 2018 to 30th March 2020. Institutional ethical clearance was obtained vide letter number KIMS:ETHCS COMM: 108/2: 2018-19. The patients were enrolled into the study after obtaining written consent from them or their attendants.

Sample size calculation: The sample size was calculated using the following formula:

n=(z)2pq/d2 n=sample size, CI=95%, d=0.2, z=1.96, p=0.12, q(100-p)=0.88
n =(1.96)2×0.12×0.88/(0.2)2×10
n =102

Inclusion criteria: All hospitalised AECOPD patients with worsening breathlessness along with increased purulence or quantity of sputum were included.

Exclusion criteria: Present or previous case of Ischaemic Heart Disease (IHD), acute myocardial infarction and renal failure were excluded.

Patients’ demographic details, history, duration of COPD, co-morbid condition like Type 2 Diabetes mellitus and systemic hypertension, history of smoking and alcohol consumption were noted. Investigations included complete blood count, renal function tests, serum electrolytes, C-reactive Protein (CRP), liver function tests, ECG, ECHO and chest X-ray. Association of cardiac troponin I and acute exacerbation of COPD was evaluated. Normal range of cTnI was considered to be between 0 and 0.01 ng/mL. A positive cTnI test was 0.01 ng/mL or higher.

Statistical Analysis

Data was analysed using Statistical Package for Social Sciences (SPSS) version 22.0 software. A p-value of <0.05 was considered as statistically significant. Chi-square test was used as test of significance for qualitative data. Pearson correlation was done to find the correlation between quantitative and qualitative variables.


The study group comprised of 102 AECOPD patients. These patients were admitted in medical wards, and ICU. Mean age of the study population was 64.22±10.611 years. Majority of the study population were in the age group 61 to 70 years (33.3%). Total 71 (69.6%) patients were males, and 31 (30.4%) were females.

The cTnI was positive in 43 (42.2%) patients and negative in 59 (57.8%) patients. There was a non-significant difference in cTnI level in relation to (age, sex, smoking habits and causes of exacerbation p>0.05), but a significant difference with severity of exacerbation (p<0.05) (Table/Fig 1).

There was a significant positive correlation between duration of COPD, and Troponin I. i.e. with increase in duration of COPD, there was increase in Troponin I levels (Table/Fig 2).

There was a significant difference in Troponin elevation in relation to sinus tachycardia and P-pulmonale, Mean Pulmonary Artery Pressure (mPAP) but a non significant difference as regards Atrial Fibrillation (AF) among the AECOPD patients (Table/Fig 3). There was a significant difference in Troponin elevation with regards to CRP and White Blood Cells (WBC) count among the studied AECOPD patients (Table/Fig 4).

(Table/Fig 5) and (Table/Fig 6) shows a significant difference in Troponin level in relation to the time since admission, need for mechanical ventilation, and outcome (p<0.05), as cTnI positivity was more prominent among patients with AECOPD. Cases which had elevated cTnI levels had increased need of NIV (74.4%), and invasive mechanical ventilation (11.6%) and increased duration of hospital stay. In the group with increased troponin I, higher mortality (34.9%) was observed because of cardiorespiratory arrest. Serum cTnI level showed a weak but positive significant correlation with the duration of hospitalisation, PASP, WBC and CRP (Table/Fig 7).


Cardiac troponin I (cTnI) assay measures cardio-specific components and is a marker for cardiac muscle cell injury. It has no cross reactivity with the two skeletal muscle isoforms. In cardiac injury, CTnI is a highly sensitive and long-lasting marker (7),(8). In the present study, cTnI was elevated (above 0.01 ng/mL) in 42.2% of AECOPD patients, the mean age of patient with positive cTnI was 59±7.5 years, and the mean age of patients with negative cTnI was 60.5±7.2 years (Table/Fig 1). This is similar to the findings by Baillard C et al., (3), who found no difference between positive and negative cTnI in relation to age.

The effect of smoking on cardiac troponin I in the published studies (3,9) and the present study showed no significant statistical difference. Contrarily, Antonelli Incalzi R et al., demonstrated that history of smoking, age, hypertension, and diabetes are common and led to a high prevalence of cardiac co-morbidity (10).

There was a significant statistical difference between patients with P-pulmonale and those without P-pulmonale. But there was no significant statistical difference between cTnI positive and negative patients with AF. This is in agreement with Baillard C et al (3), who found no significant effect of AF on cTnI positivity.

Sinus tachycardia showed a significant statistical difference between cTnI positive and negative patients. This is in agreement with the findings by Noble JS et al., who reported a significant cTnI elevation in patients with tachycardia (7).

There was a significant statistical difference between patients with high PAP in cTnI positivity. These findings are in agreement with those of Youssef et al, (11) and Aksay E et al., (12), who reported a significant effect of right ventricular dysfunction on cTnI elevation. Harvey MG and Hancox RJ (13) suggested that acute exacerbation causes cardiac damage and Troponin release.

In AECOPD, there occurs hypoxia and acidosis due to sepsis and/or metabolic stress which in turn causes acute elevation of PAP and cardiac damage. Hasaneen N et al., and Seyhan EC et al., found a strong correlation between right ventricular dysfunction and cTnI in a group of AECOPD patients (14),(15).

CRP level was raised in cTnI positive patients (97.7%). There was a positive correlation between elevated CRP and longer hospital stay with greater need for non invasive ventilation. These findings are in agreement with findings of Lokeswaran S et al., (16), the incidence cTnI was 64%. CRP elevation was present in 94.2%. They reported positive correlation between elevated CRP, and increased duration of hospital stay.

As regards the need for MV, cTnI positivity was more prominent among patients who were on NIV support (74.4%) and invasive mechanical ventilator support (11.6%) (Table/Fig 6). This is in agreement with the findings by Baillard C et al., (3) and Martins CS et al., (17).

Patients with respiratory failure or shock needs supportive care as mechanical ventilation. It worsen the right ventricular function and limitis diastolic filling of the right ventricule (18).

In this study, serum cTnI level showed significant correlation with the duration of hospitalisation (Table/Fig 5),(Table/Fig 7), where cTnI positivity was more prominent in patients with longer duration. This could be attributed to the more severity of the disease and exacerbation. Martin CS etal., and King DA et al., found that patients with more days in the hospital has high cTnI level than those with shorter duration (17),(19).

As regards survival, patients with higher cTnI had a higher mortality. These findings are in agreement with few other studies that (3),(11),(20) reported high mortality and the positive predictive value of having a high cTnI level. In-ICU and in-hospital mortality were higher in patients who reported an elevated cTnI at admission.

The above findings suggest that cardiac injury exists in patients with exacerbation of COPD. Cardiac muscle injury the due to increased work of breathing, increased left ventricular afterload, worsening of pulmonary hypertension, hypoxemia and hypercapnia (13).

The patients with elevated cTnI levels in AECOPD cases were identified as a group with high risk for complications and mortality. It is important to identify these subgroups early and undertake appropriate treatment helps in good outcome.


The present study was limited by the fact that the long-term outcome associated with cTnI elevation could not be known.


The study reported an elevated cTnI in acute exacerbation of COPD patients. Need for ICU admission and ventilator support was significantly more in cTnI positive patients. In AECOPD patients cTnI ≥0.01 ng/mL may be considered as a biomarker to predict morbidity, longer hospital stay, and higher mortality. Thus, cTnI levels at admission can be used to triage patients who are at a higher risk.


Global Initiative for Chronic Obstructive Lung Disease, 2020. 2020 Report: Global Strategy for the Diagnosis, Management and Prevention of COPD. Available at: Accessed 5 November 2019.
Celli BR, MacNee W; ATS/ERS Task Force. Standards for the diagnosis and treatment of patients with COPD: A summary of the ATS/ERS position paper. Eur Respir J. 2004;23(6):932-46. [crossref] [PubMed]
Baillard C, Boussarsar M, Fosse JP, Girou E, Le Toumelin P, Cracco C, et al. Cardiac troponin I in patients with severe exacerbation of chronic obstructive pulmonary disease. Intensive Care Med. 2003;29(4):584-9. [crossref] [PubMed]
Jeremias A, Gibson CM. Narrative review: alternative causes for elevated cardiac troponin levels when acute coronary syndromes are excluded. Ann Intern Med. 2005;142(9):786-91. [crossref] [PubMed]
Render ML, Weinstein AS, Blaustein AS. Left ventricular dysfunction in deteriorating patients with chronic obstructive pulmonary disease. Chest. 1995;107(1):162-8. [crossref] [PubMed]
Jones PW, Agusti AG et al. Outcomes and markers in the assessment of chronic obstructive pulmonary disease. Eur Respir J. 2006;27(4):822-32. [crossref] [PubMed]
Noble JS, Reid AM, Jordan LV, Glen AC, Davidson JA. Troponin I and myocardial injury in the ICU. Br J Anaesth. 1999;82(1):41-6. [crossref] [PubMed]
Allan S Jaffe, Jan Ravkilde, Robert Roberts, Ulf Naslund, Fred S, Apple Marcello Galvani and Hugo Katus et al, It’s time for a change to a troponin standard, Circulation 102 (2000) 1216-1220. [crossref] [PubMed]
Deveci F, Turgut T, Tug T et al, Cardiac Troponin Levels in Patients with COPD, Toraks Dergisi 7 (2006) 95-100.
Antonelli Incalzi R, Fuso L, De Rosa M, Forastiere F, Rapiti E, Nardecchia B, Pistelli R et al. Co-morbidity contributes to predict mortality of patients with chronic obstructive pulmonary disease. Eur Respir J. 1997;10(12):2794-800. [crossref] [PubMed]
Abdel Rahim I. Youssef, Adel Salah A. Hassan, Reda El-Ghamry, Ayman E. Ahmed et al. Serum Troponin-I as a prognostic marker in acute exacerbated chronic obstructive pulmonary disease patients,Egyptian Journal of Chest Diseases and Tuberculosis,Volume 62, Issue 4,2013,Pages 549-555. [crossref]
Aksay E, Yanturali S, Kiyan S. Can elevated troponin I levels predict complicated clinical course and inhospital mortality in patients with acute pulmonary embolism? Am J Emerg Med. 2007;25(2):138-43. [crossref] [PubMed]
Harvey MG, Hancox RJ. Elevation of cardiac troponins in exacerbation of chronic obstructive pulmonary disease. Emerg Med Australas. 2004;16(3):212-5. [crossref] [PubMed]
Hasaneen, N., Abd Elrahman, A., El Mahdy, M. et al. Evaluation of serum troponin I in patients with acute exacerbations of chronic obstructive pulmonary disease. Egypt J Bronchol 9, 14-19 (2015).
Seyhan EC, Altin S, Cetinkaya E. Importance of PROBNP and troponin I values in finding relation between cardiac origin of COPD attacks,Sunday 10 (45-12) (2007) 45.
Srivatsa Lokeswaran, Asmita A Mehta et al. Cardiac Troponin I in patients with exacerbation of chronic obstructive pulmonary disease. Pulmon. 2019;21(3):143-150.
Martins CS, Rodrigues MJ, Miranda VP, Nunes JP. Prognostic value of cardiac troponin I in patients with COPD acute exacerbation. Neth J Med. 2009;67(10):341-49.
Raoof S, Khan FA. Book Reviews: Mechanical Ventilation Manual. Journal of Intensive Care Medicine. 1999;14(5):249-250. [crossref]
King DA, Codish S, Novack V, Barski L, Almog Y et al. The role of cardiac troponin I as a prognosticator in critically ill medical patients: A prospective observational cohort study. Crit Care. 2005;9(4):R390-95. [crossref] [PubMed]
Fruchter O, Yigla M et al. Cardiac troponin-I predicts long-term mortality in chronic obstructive pulmonary disease. COPD. 2009;6(3):155-61. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2023/53336.17406

Date of Submission: Nov 17, 2021
Date of Peer Review: Dec 29, 2021
Date of Acceptance: May 13, 2022
Date of Publishing: Jan 01, 2023

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Nov 18, 2021
• Manual Googling: Jul 16, 2022
• iThenticate Software: Sep 21, 2022 (25%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)