Cardiac Troponin I Is an Independent Predictor for Mortality in Hospitalized Patients With COVID-19

Nie, Shao Fang; Yu, Miao; Xie, Tian; Yang, Fang; Wang, Hong Bo; Wang, Zhaohui; Li, Ming; Gao, Xing Li; Lv, Bing; Wang, Shi Jia; Zhang, Xiao Bo; He, Shao Lin; Qiu, Zhi Hua; Liao, Yuan; Zhou, Zi Hua; Cheng, Xiang

doi:10.1161/circulationaha.120.048789

Cited by 56 publications

(78 citation statements)

References 5 publications

(7 reference statements)

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“…In 9 studies (1470 patients) [ 30 , 31 , 34 , 41 , 48 , 52 , 53 , 56 , 64 ], the prevalence of elevated troponins during the course of hospital stay was reported; the pooled estimate was 34.2% (95% CI 26.2–42.6 %) (Figure S 3 ). Seven studies (814 patients) enrolled only patients admitted to ICU [ 26 , 29 , 40 , 42 , 58 , 62 , 63 ], and the pooled prevalence of elevated troponins was 38.0% (95% CI 28.2–48.3%) (Figure S 4 ).…”

Section: Resultsmentioning

confidence: 99%

“…In 28 studies [ 13 – 15 , 25 – 27 , 31 , 32 , 34 , 37 , 38 , 41 , 43 – 46 , 48 , 49 , 51 , 52 , 55 , 57 , 61 , 65 , 67 , 68 , 70 , 71 ], data on the relationship between troponins (on admission or during hospital stay) and mortality of patients with covid-19 could be extracted. The risks of bias of these studies in assessing the prognostic value of troponins are summarised in Table S 4 .…”

Section: Resultsmentioning

confidence: 99%

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Prevalence and prognostic value of elevated troponins in patients hospitalised for coronavirus disease 2019: a systematic review and meta-analysis

et al. 2020

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Background The clinical significance of cardiac troponin measurement in patients hospitalised for coronavirus disease 2019 (covid-19) is uncertain. We investigated the prevalence of elevated troponins in these patients and its prognostic value for predicting mortality. Methods Studies were identified by searching electronic databases and preprint servers. We included studies of hospitalised covid-19 patients that reported the frequency of troponin elevations above the upper reference limit and/or the association between troponins and mortality. Meta-analyses were performed using random-effects models. Results Fifty-one studies were included. Elevated troponins were found in 20.8% (95% confidence interval [CI] 16.8–25.0 %) of patients who received troponin test on hospital admission. Elevated troponins on admission were associated with a higher risk of subsequent death (risk ratio 2.68, 95% CI 2.08–3.46) after adjusting for confounders in multivariable analysis. The pooled sensitivity of elevated admission troponins for predicting death was 0.60 (95% CI 0.54–0.65), and the specificity was 0.83 (0.77–0.88). The post-test probability of death was about 42% for patients with elevated admission troponins and was about 9% for those with non-elevated troponins on admission. There was significant heterogeneity in the analyses, and many included studies were at risk of bias due to the lack of systematic troponin measurement and inadequate follow-up. Conclusion Elevated troponins were relatively common in patients hospitalised for covid-19. Troponin measurement on admission might help in risk stratification, especially in identifying patients at high risk of death when troponin levels are elevated. High-quality prospective studies are needed to validate these findings. Systematic review registration PROSPERO CRD42020176747

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Prevalence and prognostic value of elevated troponins in patients hospitalised for coronavirus disease 2019: a systematic review and meta-analysis

et al. 2020

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“… 2 Cardiac injury reflected by elevated cardiac troponin I (cTnI) concentrations among infected patients has been shown in multiple studies, and was also shown to be a predictor of mortality. 3 , 4 , 5 Among those with elevated cTnI, it is unknown whether higher values are associated with a further increase in mortality. Thus, the primary objectives of our study are: (i) to determine if elevated cTnI is an independent predictor of mortality in hospitalized Covid-19 patients, and (ii) whether incremental cTnI values are associated with further increase in mortality in the same cohort.…”

Section: Introductionmentioning

confidence: 99%

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

Shah

Doshi

Chenna

et al. 2020

The American Journal of Cardiology

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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.

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“…Coronavirus disease 2019 (COVID-19), the pandemic caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2), is a respiratory illness with potential cardiovascular (CV) involvement [ 1 , 2 ]. Elevated cardiac troponin (cTn), a marker of cardiac injury, is detectable in a significant proportion of COVID-19, especially in the most severe cases [ 3 ]. Myocarditis is one of the possible causes of cTn elevation and a reason for concern particularly in athletes, in which it may conspire with cardiac adaptations to exercise, resulting in a pro-arrhythmic substrate [ 1 ].…”

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confidence: 99%

“…Raised cardiac markers in COVID-19 infection during the acute phase are associated with poor prognosis [ 3 ]. This elevation has several potential mechanisms, including direct cardiac myocyte infection, cytokine storm, hypoxia-mediated damage, or microvascular endothelitis [ 1 ].…”

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confidence: 99%

Interpretation of elevated high-sensitivity cardiac troponin I in elite soccer players previously infected by severe acute respiratory syndrome coronavirus 2

Mascia

Pescetelli

Baldari³

et al. 2021

International Journal of Cardiology

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Cardiac Troponin I Is an Independent Predictor for Mortality in Hospitalized Patients With COVID-19

Cited by 56 publications

References 5 publications

Prevalence and prognostic value of elevated troponins in patients hospitalised for coronavirus disease 2019: a systematic review and meta-analysis

Prevalence and prognostic value of elevated troponins in patients hospitalised for coronavirus disease 2019: a systematic review and meta-analysis

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

Interpretation of elevated high-sensitivity cardiac troponin I in elite soccer players previously infected by severe acute respiratory syndrome coronavirus 2

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