Cardiac Troponin-I and COVID-19: A Prognostic Tool for In-Hospital Mortality
Baher Al Abbasi1, Pedro Torres1, Fergie Ramos-Tuarez2
1Department of Internal Medicine, University of Miami/JFK Medical Center Palm Beach Regional GME Consortium, Atlantis, FL, USA.
Insights
Elevated cardiac troponin-I levels in COVID-19 patients indicate a higher risk of in-hospital death. A normal troponin-I level within 24 hours predicts a better survival outcome for coronavirus disease 2019 patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Coronavirus disease 2019 (COVID-19) has caused over 800,000 global fatalities.
- There is an urgent need for prognostic tools to predict survival and hospitalization in COVID-19 patients.
Purpose of the Study:
- To investigate the utility of cardiac troponin-I levels for early prognostication in COVID-19 patients.
- To determine if troponin-I levels can predict in-hospital mortality.
Main Methods:
- Retrospective cohort study of 257 COVID-19 patients admitted between March 2020 and July 2020.
- Patients were stratified into elevated vs. normal cardiac troponin-I groups within 24 hours of admission.
- Analysis focused on demographic, clinical characteristics, and in-hospital mortality.
Main Results:
- Patients with elevated troponin-I were older and had more comorbidities (hypertension, diabetes, atrial fibrillation, coronary artery disease, heart failure).
- Elevated troponin-I was associated with significantly higher in-hospital mortality (52% vs. 10%, P < 0.0001).
- Troponin-I had a negative predictive value of 89.7% and a positive predictive value of 51.9% for mortality.
Conclusions:
- Troponin-I elevation is common in COVID-19 and linked to fatal outcomes.
- A normal troponin-I level in the first 24 hours has a high negative predictive value for mortality.
- Normal troponin-I levels predict favorable survival in hospitalized COVID-19 patients.
Background:
The number of fatalities due to coronavirus disease 2019 (COVID-19) is escalating with more than 800,000 deaths globally. The scientific community remains in urgent need of prognostic tools to determine the probability of survival in patients with COVID-19 and to determine the need for hospitalization.
Methods:
This is a retrospective cohort study of patients with a diagnosis of COVID-19 admitted to a tertiary center between March 2020 and July 2020. Patients age 18 years and older were stratified into two groups based on their troponin-I level in the first 24 h of admission (groups: elevated vs. normal). The aim of the study is to explore the utility of cardiac troponin-I level for early prognostication of patients with COVID-19.
Results:
This cohort of 257 patients included 122/257 (47%) women with a mean age of 63 ± 17 years. Patients with an elevated troponin-I level were more likely to be older (77 ± 13 vs. 58 ± 16 years, P < 0.0001), have a history of hypertension (P < 0.0001), diabetes mellitus (P = 0.0019), atrial fibrillation or flutter (P = 0.0009), coronary artery disease (P < 0.0001), and chronic heart failure (P = 0.0011). Patients with an elevated troponin-I level in the first 24 h of admission were more likely to have higher in-hospital mortality (52% vs. 10%, P < 0.0001). Troponin-I level in the first 24 h of admission had a negative predictive value of 89.7% and a positive predictive value of 51.9% for all-cause in-hospital mortality.
Conclusions:
Troponin-I elevation is commonly seen in patients with COVID-19 and is significantly associated with fatal outcomes. However, a normal troponin-I level in the first 24 h of admission had a high negative predictive value for all-cause in-hospital mortality, thereby predicting favorable survival at the time of discharge.
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