High sensitivity Troponin-T for prediction of adverse events in patients with COVID-19

Abstract

Background: High sensitivity troponin-T (hs-TnT) has been associated with mortality in patients hospitalized with COVID-19. We aimed to determine if hs-TnT levels and their timing are independent predictors of adverse events in these patients. Design: Retrospective chart review was performed for all patients hospitalized at our institution between March 23 rd and April 13 th , 2020 who were found to be COVID-19-positive. Clinical, demographic, and laboratory variables including initial and peak hs-TnT were recorded. Univariable and multivariable analyses were completed for a primary composite endpoint of inhospital death, intubation, need for critical care, or cardiac arrest. Results: In the 276 patients analyzed, initial hs-TnT above the median (17ng/L) was associated with increased length of stay, need for vasoactive medications, and death, along with the composite endpoint (OR 3.92, p < 0.001). Multivariable analysis demonstrated that elevated initial hs-TnT was independently associated with the primary endpoint (OR 2.92, p = 0.01). Latepeaking hs-TnT (OR 2.19 for each additional day until peak, p < 0.001) was also independently associated with the composite endpoint. Conclusions: In patients hospitalized with COVID-19, hs-TnT identifies patients at high risk for adverse in-hospital events, and trends of hs-TnT over time, particularly during the first day, provide additional prognostic information.

Epidemiological and clinical presentations of hospitalized COVID-19 patients in Libya: An initial report from Africa

“…We observed higher values among the non-survivor group than the survivor group, which is consistent with recent studies indicating derangement of liver function tests associated with severe COVID-19 [ 45 ]. Further, the high troponin level was associated with increased mortality, consistent with the findings of recent studies that showed that higher troponin was associated with a longer hospital stay and death [ 46 ].…”

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

“…Many critically ill COVID-19 patients demonstrate concomitant elevations in acute phase reactants such as procalcitonin (PCT), serum ferritin, erythrocyte sedimentation rate (ESR), CRP, interleukin (IL)-6 and the natriuretic peptides 23 , supporting the main reason of a cardio-inflammatory response. It has been reported that elevated cTn served as a marker of risk of future adverse events based on the current severity of the infectious disease and inflammatory process, but not necessarily as a marker of hard cardiovascular outcomes 24 . In clinical practice, however, it is challenging to determine whether elevated cTnI levels are caused by direct COVID-19 infection or by the progress of these preexisting medical conditions 25 .…”

“…We used nationwide data and had a large sample size, which emphasizes the prevalence and prognostic role of cTn in COVID-19. We used the only cTn values at admission; however, the serial measurements of cTn during hospitalization might also be an important marker of severity and prognosis despite the normal initial level at admission 5 , 12 , 15 , 16 , 24 , 29 . The other limitation of our study was the analytic accuracy of the prognosticative value of cTn, given the different assays used at each hospital.…”

Echocardiography, Lung Ultrasound and Cardiac Magnetic Resonance Findings in COVID-19: A Systematic Review

“…Given increasing evidence for cardiovascular manifestations of COVID-19, and the increasing role of bedside focused cardiac ultrasound (FoCUS) in clinical management, there may be utility in performing a focused bedside ECHO among patients with COVID-19, especially in the critically ill [3][4][5]. Although performing an ECHO solely based on troponin elevation is not recommended, there is an increasing body of data suggesting that elevated troponin (>99 th percentile on admission) is an important predictor of mortality and length of hospital stay in patients with COVID-19 [6][7][8][9][10]. Similarly, NT-ProBNP has also been found to be elevated among a significant number of patients with COVID-19 and is an important predictor of mortality [11].…”