Admission High-Sensitive Cardiac Troponin T Level Increase Is Independently Associated with Higher Mortality in Critically Ill Patients with COVID-19: A Multicenter Study

Abstract

Background: In coronavirus disease 2019 (COVID-19) patients, increases in high-sensitive cardiac troponin T (hs-cTnT) have been reported to be associated with worse outcomes. In the critically ill, the prognostic value of hs-cTnT, however, remains to be assessed given that most previous studies have involved a case mix of non- and severely ill COVID-19 patients. Methods: We conducted, from March to May 2020, in three French intensive care units (ICUs), a multicenter retrospective cohort study to assess in-hospital mortality predictability of hs-cTnT levels in COVID-19 patients. Results: 111 laboratory-confirmed COVID-19 patients (68% of male, median age 67 (58–75) years old) were included. At ICU admission, the median Charlson Index, Simplified Acute Physiology Score II, and PaO2/FiO2 were at 3 (2–5), 37 (27–48), and 140 (98–154), respectively, and the median hs-cTnT serum levels were at 16.0 (10.1–31.9) ng/L. Seventy-five patients (68%) were mechanically ventilated, 41 (37%) were treated with norepinephrine, and 17 (15%) underwent renal replacement therapy. In-hospital mortality was 29% (32/111) and was independently associated with lower PaO2/FiO2 and higher hs-cTnT serum levels. Conclusions: At ICU admission, besides PaO2/FiO2, hs-cTnT levels may allow early risk stratification and triage in critically ill COVID-19 patients.

Use and Prognostic Implications of Cardiac Troponin in COVID-19

“…As shown in Figure 2 , the frequency of myocardial injury varies widely probably in relation to patient selection. In studies of patients admitted to Intensive Care Units (ICU), the frequency of myocardial injury is as high as or >50% 32 , 46 , 47 . Studies that include a broader spectrum of patients suggest a frequency that ranges from 10% 48 , 49 to more than 45% 26 , 27 , 50 , 51 , 52 .…”

Biomarkers in the management of acute heart failure: state of the art and role in COVID‐19 era

“… 136 Several other studies have confirmed the relationship between high troponin values and a worse prognosis in patients with COVID‐19 infection. 126 , 137 , 138 , 139 It is still not clear whether this relationship is due to a more severe form of COVID‐19 or to a more extensive cardiac damage or both. 135 Troponin elevation during SARS‐COV‐2 infection can be underpinned by several causes.…”

“…In another recently published article, high concentrations of CK‐MP, procalcitonin, NT‐proBNP, BNP, troponin, and D‐dimers have been shown to predict severity and survival for patients with COVID‐19 as well 136 . Several other studies have confirmed the relationship between high troponin values and a worse prognosis in patients with COVID‐19 infection 126,137–139 . It is still not clear whether this relationship is due to a more severe form of COVID‐19 or to a more extensive cardiac damage or both 135 .…”

“…At the same time, no established therapies exist for myocardial injury associated with COVID‐19; however, dosing these biomarkers is a useful tool to stratify patients' risk and therefore predict a more severe course of the disease and the need for a more aggressive approach such as invasive mechanical ventilation 137,138 . In addition, Yuan et al .…”

“…132 At the same time, no established therapies exist for myocardial injury associated with COVID-19; however, dosing these biomarkers is a useful tool to stratify patients' risk and therefore predict a more severe course of the disease and the need for a more aggressive approach such as invasive mechanical ventilation. 137,138 In addition, Yuan et al conducted a study involving patients with COVID-19 infection with the aim of investigating whether biomarkers may indicate safe delay in transthoracic echocardiography until the risk of infection recedes. The study proved that troponin and BNP levels were highly correlated with urgent need for transthoracic echocardiography.…”