The prognostic role of cardiac troponin in hospitalized COVID-19 patients

Abstract

Background and aim Myocardial injury defined by elevation of cardiac troponins (cTn) in the course of coronavirus disease 2019 (COVID-19) pandemic has been reported, though not fully characterized yet. Using the Turkish nationwide centralized COVID-19 database, we sought to determine whether cTn measured within 24 hours of admission may help identify 30-day all-cause mortality in hospitalized patients. Methods This retrospective cohort study was conducted at all hospitals in Turkey between March 11, 2020, and June 22, 2020. All hospitalized COVID-19 patients (≥18 years) who had cTn measurements within 24 hours of admission were included. The primary outcome was 30-day all-cause mortality. Results A total of 14,855 COVID-19 patients (median age 49 years and 54% male) from 81 provinces of Turkey were included. Of these, 2020 patients (13.6%) were transferred to intensive care unit, 1165 patients (7.8%) needed mechanical ventilation, and 882 patients (5.9%) died during hospitalization. The prevalence of cTn positivity was 6.9% (n = 1027) in the hospitalized patients. cTn positivity was 5% in those patients alive at 30-day, and 44% in those who died. In multivariable Cox proportional hazard regression model, age, lactate dehydrogenase, and cTn were the strongest predictors of 30-day mortality, irrespective of cTn definition as a continuous, ordinal variable, or dichotomic variables. Conclusions A single measurement of cTn at admission in patients with COVID-19 is associated with 30-day all-cause mortality and may have an important prognostic role for optimizing risk stratification.

COVID-19 and Heart Failure: From Epidemiology During the Pandemic to Myocardial Injury, Myocarditis, and Heart Failure Sequelae

“…After adjusting for multiple variables (e.g., age, pre-existing cardiovascular diseases, cerebrovascular diseases, diabetes mellitus, chronic obstructive pulmonary disease, renal failure, cancer, ARDS, creatinine levels, and NT-proBNP levels), the hazard ratio (HR) for death among patients with cardiac injury was 4.26 (95% CI, 1.92–9.49), p < 0.01 ( 39 ). The prognostic role of cardiac injury was confirmed in further and larger studies from different countries (including European, American, and Asiatic nations), with mortality HR ranging from 1.12 to 8.9 depending on the regression model used and OR up to 80 in a single univariate model ( 17 , 71 – 82 ) ( Table 3 ). Data from a recent meta-analysis including 12,262 patients from 13 studies summarized that elevated Tn is associated with increased mortality (OR, 4.75; 95% CI, 4.07–5.53; p < 0.001; I 2 = 19.9%), with 55% sensitivity and 80% specificity ( 83 ).…”

“…Since the first Chinese reports, a high incidence of cardiac injury, defined as the presence of elevated troponin (Tn) levels above the 99th percentile of the reference interval, was found in COVID-19 patients. The prevalence of cardiac injury ranges from 12% in unselected COVID-19 cases up to 41% in critically ill patients and patients with pre-existing cardiovascular diseases with a further rise to 75.8% in nonsurvivors (Table 3) (14,17,18,24,25,38,39,(71)(72)(73)(74)(75)(76)(77)(78)(79)(80)(81)(82). The presence of elevated Tn levels is associated with abnormal laboratory findings (including white blood cells count, neutrophil and lymphocyte count, C-reactive protein, procalcitonin, Nterminal pro-B-type natriuretic peptide, D-dimer, transaminases, lactate dehydrogenase, total bilirubin, albumin, prothrombin time, and cytokines) (18) and a higher grade of pulmonary involvement in radiographic findings, suggesting an important multiorgan involvement (21,38,73).…”

“…The presence of cardiac injury in COVID-19 is associated with more severe manifestations, complications, and adverse prognosis (14,17,18,24,25,38,39,(71)(72)(73)(74)(75)(76)(77)(78)(79)(80)(81)(82). Data about the association between cardiac injury and mortality are summarized in Table 3.…”

“…This may be a consequence of the derangement in the innate and adaptive immune response, with a cytokine storm, similar to that previously observed in SARS and Middle East Respiratory Syndrome (MERS) ( 3 ). The presence of cardiac injury in COVID-19 is associated with more severe manifestations, complications, and adverse prognosis ( 14 , 17 , 18 , 24 , 25 , 38 , 39 , 71 – 82 ). Data about the association between cardiac injury and mortality are summarized in Table 3 .…”

Myocardial Injury Predicts Risk of Short-Term All-Cause Mortality in Patients With COVID-19: A Dose–Response Meta-Analysis

“…Till now, the predictive value of myocardial injury in patients with COVID-19 during the in-hospital term or short term is mixed. A series of studies have shown that myocardial injury in patients with COVID-19 is very common and associated with higher mortality ( 12 – 22 ). However, other studies indicated that the influence of myocardial injury is attenuated after adjusting multiple severe diseases ( 23 , 24 ).…”