Time to move from prognostication to diagnosis and treatment of heart disease in acute exacerbation of COPD

In this edition of the journal, Laribi et al . [1] report the incremental value of biomarkers relative to the CURB-65 score for predicting 30-day mortality in acute exacerbations of chronic obstructive pulmonary disease (COPD). The derivation cohort of 356 elderly patients combined four single centre studies of consecutive emergency department attendees, 12% being subsequently admitted to the intensive care unit (ICU). Cardiovascular comorbidity was common (41% hypertension, 20% heart failure). The primary end-point of 30-day mortality occurred in 27 patients (7.6%), congruent with existing literature reporting variable rates of 4.6–12% short-term mortality [2, 3]. The authors focus on the performance of myocardial injury markers, recognising that cardiac disease is a common cause of death in patients with COPD [4]. The link between copeptin, troponin and mortality indicates a strong need for examining cardiac mechanisms in AECOPD