Clinical predictors of acute cardiac injury and normalization of troponin after hospital discharge from COVID-19

Abstract

Background Although acute cardiac injury (ACI) is a known COVID-19 complication, whether ACI acquired during COVID-19 recovers is unknown. This study investigated the incidence of persistent ACI and identified clinical predictors of ACI recovery in hospitalized patients with COVID-19 2.5 months post-discharge. Methods This retrospective study consisted of 10,696 hospitalized COVID-19 patients from March 11, 2020 to June 3, 2021. Demographics, comorbidities, and laboratory tests were collected at ACI onset, hospital discharge, and 2.5 months post-discharge. ACI was defined as serum troponin-T (TNT) level >99th-percentile upper reference limit (0.014ng/mL) during hospitalization, and recovery was defined as TNT below this threshold 2.5 months post-discharge. Four models were used to predict ACI recovery status. Results There were 4,248 (39.7%) COVID-19 patients with ACI, with most (93%) developed ACI on or within a day after admission. In-hospital mortality odds ratio of ACI patients was 4.45 [95%CI: 3.92, 5.05, p<0.001] compared to non-ACI patients. Of the 2,880 ACI survivors, 1,114 (38.7%) returned to our hospitals 2.5 months on average post-discharge, of which only 302 (44.9%) out of 673 patients recovered from ACI. There were no significant differences in demographics, race, ethnicity, major commodities, and length of hospital stay between groups. Prediction of ACI recovery post-discharge using the top predictors (troponin, creatinine, lymphocyte, sodium, lactate dehydrogenase, lymphocytes and hematocrit) at discharge yielded 63.73%-75.73% accuracy. Interpretation Persistent cardiac injury is common among COVID-19 survivors. Readily available patient data accurately predict ACI recovery post-discharge. Early identification of at-risk patients could help prevent long-term cardiovascular complications. Funding None

Outcomes of Hospitalized Patients With COVID-19 With Acute Kidney Injury and Acute Cardiac Injury

“…Additional and prospective studies are needed. We did not investigate the effects of anticoagulants on organ injuries ( 50 , 51 ), the status of the COVID-19 survivors at discharge ( 52 , 53 ) and the longer-term outcomes ( 54 ). As with any retrospective study, there could be unintended patient selection bias and unaccounted confounders.…”

Persistent cardiac injury – An important component of long COVID-19 syndrome

“…We read with interest the article by Lu et al. 5 on the importance of persistent cardiac injury in patients with previous COVID-19 and the factors associated with its development. Among the 673 patients who developed ACI and had a follow-up visit, 371 patients (55.1%) had persistent elevation in troponin levels over a median follow-up of 2.5 months.…”

Editorial: Cardiovascular Complications at One Year After SARS-CoV-2 Infection are Independent of Underlying Cardiovascular Risk Factors or Severity of COVID-19

“…Acute and long-term cardiovascular disease associated with SARS-CoV-2 infection may be driven by an imbalance between disintegrin and metalloproteinase domain-containing protein 17 (ADAM17) required to cleave ACE2 and TMPRSS2 [ 4 ]. However, until recently, the post-acute effects of SARS-CoV-2 infection on the cardiovascular system have not been studied in large populations or in a controlled way [ 6 , 7 ].…”

“…Lu and colleagues recently reported the findings from a retrospective study of 10,696 patients hospitalized with COVID-19 between March 2020 to June 2021 [ 6 ]. Serum troponin-T levels evaluated acute cardiac injury (ACI) during hospitalization and up to 2.5 months following discharge [ 6 ].…”

“…Lu and colleagues recently reported the findings from a retrospective study of 10,696 patients hospitalized with COVID-19 between March 2020 to June 2021 [ 6 ]. Serum troponin-T levels evaluated acute cardiac injury (ACI) during hospitalization and up to 2.5 months following discharge [ 6 ]. On hospital admission, 39.7%, or 4,248 patients with COVID-19, had ACI, which developed in almost all patients (93%) within a day after hospital admission [ 6 ].…”