The CANT score: Predicting mortality in exacerbations of chronic obstructive pulmonary disease

Shafuddin, Eskandarain; Cooray, Manisha; Tuffery, Christine; Hopping, Sandra; Sullivan, Glenda; Chang, Catherina L.; Hancox, Robert J.

doi:10.1183/13993003.congress-2016.oa1501

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“…CURB-65 scores were calculated on admission (one point for each of: Confusion, blood Urea level > 7 mmol/L, Respiratory rate ≥30 per minute, systolic Blood pressure < 90 mmHg or diastolic blood pressure < 60 mmHg, age ≥65 years). CURB-65 scores have been validated as a marker of prognosis in several cohorts of patients with COPD exacerbations [2,12,13], and in our hospital, they perform at least as well as other widely used scoring systems for predicting early mortality [14]. Acidaemia was defined as a blood pH < 7.30.…”

Section: Methodsmentioning

confidence: 99%

Changes in biomarkers of cardiac dysfunction during exacerbations of chronic obstructive pulmonary disease

Shafuddin

Chang

Cooray

et al. 2018

Respiratory Medicine

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Background: Cardiac dysfunction is associated with a higher mortality in exacerbations of chronic obstructive pulmonary disease (COPD). It is unknown how the heart responds to treatment of COPD exacerbations. We followed cardiac biomarker levels during hospital admissions for exacerbations of COPD and hypothesised that these biochemical markers of cardiac dysfunction might be affected the severity and treatment of exacerbations of COPD. Methods: N-terminal pro-B-type natriuretic peptide (NT-proBNP) and troponin T were measured at admission, 12 h, 72 h, and clinical stability in 176 patients. In a second cohort (n = 93), associations between blood salbutamol concentrations and biomarker changes at 12 h were analysed. Results: NT-proBNP increased from a geometric mean of 43 pmol/L at admission to 56 pmol/L at 12 h (p < 0.001), 53 pmol/L at 72 h (p = 0.045), and decreased to 25 pmol/L (p < 0.001) at stability. Troponin T levels decreased at 12 h (p < 0.001), but 15/174 (9%) patients had a clinically significant rise. Nebulised bronchodilator treatment and blood salbutamol concentrations were associated with greater increases in NT-proBNP rise at 12 h independently of baseline COPD or exacerbation severity and other treatments (p < 0.05). Nebulised bronchodilator and blood salbutamol concentrations also predicted rises in troponin T in univariate analyses (p < 0.05). Conclusions: NT-proBNP continues to rise after admission to hospital for COPD exacerbations and a minority of patients have clinically significant rises in cardiac troponins. These rises were associated with nebulised beta 2agonist treatment. These findings suggest that high doses of beta 2-agonists may exacerbate cardiac dysfunction in COPD.

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Section: Methodsmentioning

confidence: 99%