Prognostic Value of Elevated Cardiac Troponin I in Hospitalized Covid-19 Patients

Abstract

This study aimed to determine if cardiac troponin I (cTnI) is an independent predictor of clinical outcomes and whether higher values are associated with worse clinical outcomes in Covid-19 patients. This case-series study was conducted at Phoebe Putney Health System. Participants were confirmed Covid-19 patients admitted to our health system between March 2, 2020 and June 7, 2020. Data were collected from electronic medical records. Patients were divided into 2 groups: with and without elevated cTnI. The cTnI were further divided in 4 tertiles. Multivariable logistic regression analysis was performed to adjust for demographics, baseline comorbidities, and laboratory parameters including D-dimer, ferritin, lactate dehydrogenase, procalcitonin and C-reactive protein. Out of 309 patients, 116 (37.5%) had elevated cTnI. Those with elevated cTnI were older (59.9 vs. 68.2 years, p <0.001), and more likely to be males (53.5% vs. 36.3%, p = 0.003). Elevated cTnI group had higher baseline comorbidities. After multivariable adjustment, overall mortality was significantly higher in elevated cTnI group (37.9% vs. 11.4%, odds ratio:4.45; confidence interval:1.78 to 11.14, p <0.001). Need for intubation, dialysis, and intensive care unit (ICU) transfer was higher in elevated cTnI group. Among those with elevated cTnI, mortality was 23.2% for 50th percentile, 48.4% for 75th percentile, and 55.2% for 100th percentile. Similarly, further increase in cTnI was associated with a higher need for intubation, dialysis, and ICU transfer. In conclusion, myocardial injury occurs in significant proportion of hospitalized Covid-19 patients and is an independent predictor of clinical outcomes, with higher values associated with worse outcomes.

Predictors of intubation in COVID-19 patients treated with out-of-ICU continuous positive airway pressure

“…A number of investigations seeking to find relevant outcome predictors among hospitalized patients with COVID-19 have shown that, on admission, increased D-dimer concentration 11 and neutrophil-to-lymphocyte ratio 12 as well as enhanced levels of C-reactive protein, 13 creatinine 13 and cardiac troponin I 14 are all associated with a higher risk of intubation. Similarly, a body mass index (BMI) ≥35 kg/m, 15 increasing age, 15 male sex, 15 comorbid status, 13 respiratory rate, 13 and SpO 2 13 have been shown to be independently associated with worse in-hospital outcomes.…”

The role of pre-existing chronic disease in cardiac complications from SARS-CoV-2 infection: A systematic review and meta-analysis

“…20 studies measured cardiac outcomes on the day of admission [3,29,32,34,35,37–41,43–48,50-52,57], and one at the time of patient death [33], with the remaining eight studies not specifying the time of assessment [4,36,42,49,53–55]. The studies were conducted in 10 countries in four geographical locations (U.S.A. [32,33,41,48,49], the Middle East [34,50,52], Europe [4,35–40,44,45,47], and the People’s Republic of China [3,29,42,43,46,51,53–57]) with a total of 3553 COVID-19 patients developing cardiac complications and 13,225 COVID-19 patients without cardiac complications. Patients who presented with SARS-CoV-2 associated cardiac complications were, on average, 10 years older than in those who did not (Table 2).…”

“…As large heterogeneity was detected amongst the total combined study cohort, the cohort was subdivided based on general global region in an attempt to account for this. Cohorts were divided into studies with cohorts primarily situated in the U.S.A [32,33,41,48,49], the Middle East [34,50,52], Europe [4,35–40,44,45,47], and China [3,29,42,43,46,51,53–57].…”

Cardiovascular Health and Disease in the Context of COVID-19

“…Upon retrospective analysis of hs-troponin levels in 523 patients admitted to the hospital with COVID-19 in Italy, Michela et al identified hs-troponin as an independent risk factor for mortality with a hazard ratio (HR) of 1.004 for each 10-point increase in hs-troponin level (P < 0.0001) [ 82 ]. Similarly, Shah et al examined hs-troponin levels in 309 patients admitted to a US hospital with COVID-19 and found a direct correlation between cardiac troponin I (cTnI) levels and need for intubation, dialysis, transfer to the ICU and death [ 7 ]. Arcari et al suggested that both hs-troponin and NP may be particularly useful biomarkers for clinical pneumonia risk stratification [ 6 ].…”

“…On the opposite end of the spectrum, Szekely et al conducted a systematic echocardiographic study of 100 consecutive patients diagnosed with COVID-19 within 24 h of admission and found that 78% of patients had evidence of cardiac pathology [ 5 ]. Use of biomarkers, such as high-sensitivity troponin (hs-troponin) to detect myocardial injury has resulted in rates somewhere in between, with Arcari et al noting elevation in 38% of 111 patients with COVID-19 admitted to a hospital in Italy [ 6 ], and Shah et al noting elevation in 37.5% of 309 patients with COVID-19 admitted to a hospital in the southern United States [ 7 ]. Rates of cardiac involvement are harder to estimate among individuals with COVID-19 not requiring hospitalization, although a report suggesting myocardial involvement in 46% of 26 competitive college athletes with mild or no symptoms suggests that it may be relatively common even among those who are otherwise young and healthy [ 8 ].…”