The impact of daily troponin-I and D-dimer serum levels on mortality of moderate-to-severe COVID-19 pneumonia patients

Abstract

Introduction Coronavirus Disease 2019 (COVID-19) caused by that infection resulted in a very high morbidity and mortality rates globally. Purpose The aim of this study is to analyses the daily Troponin-I and D-dimer levels and their impact on the need for intensive care and mortality of the COVID-19 infected patients. Methods 206 patients who were hospitalized between 20.03.2020–05.05.2020 with a diagnosis of moderate-to-severe COVID-19 pneumonia were analyzed retrospectively. Serum Troponin-I and D-dimer levels were recorded at least 10 days. Results Average age was higher in mortality group compared to non-mortality group (respectively 67.79±14.9, 56.87±18.15, p:<0.001). Presence of hypertension, diabetes mellitus, previous coronary bypass surgery, heart failure, chronic renal failure and chronic obstructive pulmonary disease were statistically significant affecting mortality (respectively p:0.003, p:0.004, p:0.045, p:0.02, p:0.003, p:0.007). First 10 days measurements of Troponin-I and D-dimer values was associated with mortality and intensive care requirement (p<0.001). Both Troponin-I and D-dimer were higher in mortality group compared to the patients requiring intensive care. Troponin-I value on the 7th day ≥16.05 pg/ml was related with need for intensive care (AUC: 0.896, sensitivity: %78.6, specificity: %78.3, p<0.001). Troponin-I value ≥30.25 pg/ml on the 9th day was related with mortality (AUC: 0.920, sensitivity: %89.5, specificity: %89.3, p<0.001). D-dimer value ≥878 hg/ml on the 2nd day was associated with intensive care need (AUC: 0.896, sensitivity: %78.6, specificity %78.3, p<0.001). D-dimer value ≥1106 hg/ml on the 10th day was associated with mortality (AUC: 0.817, sensitivity: %68.4, specificity: %65.2, p<0.001). It was observed that hospitalization periods ≥9.5 days were associated with mortality (AUC: 0.738, sensitivity %68.4, specificity: %65.9, p<0.001). Conclusion We observed that hospitalizations ≥9.5 days increased mortality. Troponin-I and D-dimer follow-ups in serum are more effective than other inflammatory markers to show the need for intensive care and mortality. A high Troponin-I value should alert the clinician in terms of clinical deterioration. FUNDunding Acknowledgement Type of funding sources: None.

Association between Fibrinogen-to-Albumin Ratio and Prognosis of Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

“…Although previous observational studies have reported several other inflammatory or coagulation-related makers for the prediction of prognostic outcomes in patients contracting COVID-19 [ 49 , 50 ], our meta-analysis is the first to investigate the association of the F/A ratio with poor prognosis. A previous meta-analysis involving more than two thousand patients revealed significantly higher CRP levels among those who succumbed to COVID-19 than in survivors [ 51 ].…”

“…In addition, another even larger meta-analysis on over 13,000 participants recruited in 77 observational studies has demonstrated a role of the circulating level of cytokines (i.e., IL-6) in predicting severity and mortality in those diagnosed with COVID-19 [ 7 ], further underscoring a detrimental prognostic role of inflammation. In respect to the coagulation–inflammation cascade, previous observational studies have identified D-dimer and fibrinogen as poor prognostic indicators in those contracting COVID-19 [ 25 , 49 , 52 ]. Among these parameters, receiver operating characteristic (ROC) curve analysis in a previous observational study showed the superior accuracy of the F/A ratio (area under curve (AUC) = 0.808) in predicting disease severity and mortality compared with other parameters (i.e., C-reactive protein: AUC = 0.735; fibrinogen: AUC = 0.606; albumin: AUC = 0.257) [ 25 ].…”

Circulating mid-regional proadrenomedullin is a predictor of mortality in patients with COVID-19: a systematic review and meta-analysis

“…The study population we included had different severities of illness, and the overall mortality rate was 19%. Many studies have used various biomarkers, such as CRP [ 39 – 44 ], PCT [ 39 , 43 , 45 , 46 ], IL-6 [ 39 , 43 , 46 ], WBC [ 40 , 47 – 49 ], D-dimer [ 42 , 44 , 46 , 50 , 51 ], lactate dehydrogenase (LDH) [ 39 , 42 – 44 , 46 , 47 ], N-terminal pro-B-type natriuretic peptide (NT-proBNP) [ 39 , 52 , 53 ], and Troponin T [ 39 , 54 ], and critical illness scores, such as APACHE II [ 55 – 57 ], SOFA [ 55 , 56 , 58 – 60 ], SAPS [ 61 – 64 ], and CURB65 [ 59 , 61 , 65 ], to evaluate the prognosis of patients with COVID-19. The APACHE II and SOFA scoring systems require the worst values of the clinical and biological parameters to be recorded within 24 h of admission [ 66 ].…”

Circulating Mid-regional Proadrenomedullin is a predictor of mortality in patients with COVID-19: a systematic review and meta-analysis

“…The study population we included had different severities of illness, and the overall mortality rate was 19%. Many studies have used various biomarkers, such as CRP [39][40][41][42][43][44], PCT [39,43,45,46], IL-6 [39,43,46], WBC [40,[47][48][49], D-dimer [42,44,46,50,51], lactate dehydrogenase (LDH) [39,[42][43][44]46,47], N-terminal pro-B-type natriuretic peptide (NT-proBNP) [39,52,53], and Troponin T [39,54], and critical illness score, such as APACHEII [55][56][57], SOFA [55,56,[58][59][60], SAPS [61-64], and CURB65 [59,61,65], to evaluate the prognosis of patients with COVID-19. The APACHE II and SOFA scoring systems require the worst values of the clinical and biological parameters to be recorded within 24 h of admission [66].…”