Prevalence and prognostic value of cardiac troponin in elderly patients hospitalized for COVID-19

Abstract

Background: Increases in cardiac troponin (cTn) in coronavirus disease 2019 (COVID-19) have been associated with worse prognosis. Nonetheless, data about the significance of cTn in elderly subjects with COVID-19 are lacking.Methods: From a registry of consecutive patients with COVID-19 admitted to a hub hospital in Italy from 25/02/2020 to 03/07/2020, we selected those ≥60 year-old and with cTnI measured within 3 days from the molecular diagnosis of SARS-CoV-2 infection. When available, a second cTnI value within 48 hours was also extracted. The relationship between increased cTnI and all-cause in-hospital mortality was evaluated by a Cox regression model and restricted cubic spline functions with three knots.Results: Of 343 included patients (median age 75.0 (68.0-83.0) years, 34.7% men), 88 (25.7%) had cTnI above the upper-reference limit (0.046 µg/L). Patients with increased cTnI had more comorbidities, greater impaired respiratory exchange and higher inflammatory markers on admission than those with normal cTnI. Furthermore, they died more (73.9% vs. 37.3%, p<0.001) over 15 (6-25) days of hospitalization. The association of elevated cTnI with mortality was confirmed by the adjusted Cox regression model (HR: 1.61, 95%CI: 1.06-2.52, p=0.039) and was linear until 0.3 µg/L, with a subsequent plateau. Of 191 (55.7%) patients with a second cTnI measurement, 49 (25.7%) had an increasing trend, which was not associated with mortality (univariate HR 1.39, 95%CI 0.87-2.22, p=0.265).Conclusions: In elderly COVID-19 patients, an initial increase in cTn is common and predicts a higher risk of death. Serial cTn testing may not confer additional prognostic information.

Prognostic implications of serial high-sensitivity cardiac troponin testing among patients with COVID-19: A Danish nationwide registry-based cohort study

“…Our finding of adverse COVID-19 outcomes associated with myocardial injury based on serial high-sensitivity cardiac troponin assessment is in line with existing evidence [21] , [22] , [23] , [24] and underscores the value of serial cardiac troponin measurements in patients with COVID-19. However, current evidence is limited by the definitions of myocardial injury employed, lack of data on serial testing and thereby dynamic cardiac troponin changes, use of inconsistent sampling intervals, and use of non-high-sensitivity assays [12] .…”

“…Besides isolated myocardial injury or type 2 myocardial infarction, such elevations may be indicative of myocarditis or type 1 myocardial infarction and may further be associated with both increased disease severity and mortality [10] , [11] , [12] , [13] , [14] , [15] . While serial cardiac troponin testing plays crucial diagnostic and prognostic roles among patients presenting with acute-onset chest pain [16] , [17] , [18] , [19] , [20] , evolving data also suggest that serial troponin assessment may improve prognostic stratification in patients with COVID-19 [21] , [22] , [23] , [24] .…”

Admission high-sensitivity cardiac troponin levels as a prognostic indicator for in-hospital mortality rates in the elderly and very elderly COVID-19 patients

“…The study involves very elderly patients (mean age is 86 y) that are the population category more involved by a severe form of COVID-19 and who most often require hospitalization. Previous studies were shown a dichotomous relationship between cTnI elevation and mortality without different rates in mortality with increasing cTnI levels ( De Marzo et al., 2021 ; García de Guadiana-Romualdo et al., 2021 ). Interestingly, in this study mortality rates increased significantly across HS-cTnT entry levels groups (group A: 18.4%; group B: 36.4%; group C: 62.0%; p <0.001).…”

Laboratory Biomarkers for Diagnosis and Prognosis in COVID-19

“…Cardiac biomarkers ( 47 ), electrocardiography (ECG), and transthoracic echocardiography (TTE) play a pivotal role in risk stratification and early detection of cardiovascular complications, as well as to guide treatment ( 48 , 49 ). Recent evidence confirmed that cardiac biomarkers, including natriuretic peptides (NPs) and troponins, may reflect cardiovascular involvement and inflammation in COVID-19, and are strongly associated with poor prognosis and mortality ( 41 , 50 – 53 ).…”