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Using high sensitivity cardiac troponin values in patients with SARS-CoV-2 infection (COVID-19): The Padova
Laura De Michieli1, Luciano Babuin2, Stefania Vigolo3
1Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA; Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
Insights
High-sensitivity cardiac troponin I (hs-cTnI) can predict mortality in COVID-19 patients. A baseline hs-cTnI value below 5 ng/L identifies patients at low risk for adverse outcomes.
Area of Science:
- Cardiology
- Infectious Diseases
- Biomarkers
Background:
- Coronavirus Disease 2019 (COVID-19) presents a broad spectrum of illness severity.
- Early risk stratification is crucial for managing COVID-19 patients.
- Myocardial injury is a potential complication of COVID-19.
Purpose of the Study:
- To determine the frequency of myocardial injury in COVID-19 patients using high-sensitivity cardiac troponin I (hs-cTnI).
- To evaluate the prognostic value of hs-cTnI in predicting mortality among COVID-19 patients.
Main Methods:
- Retrospective study of 426 COVID-19 patients presenting to an Italian Emergency Department in 2020.
- Hs-cTnI levels were measured based on clinical judgment.
- Myocardial injury was defined as hs-cTnI values above sex-specific 99th percentile upper reference limits.
Main Results:
- 27.2% of patients exhibited myocardial injury at baseline.
- Myocardial injury was significantly associated with higher in-hospital mortality (HR=9, p<0.0001).
- An hs-cTnI level < 5 ng/L demonstrated high sensitivity (97.8%) and negative predictive value (99.2%) for identifying low-risk patients.
Conclusions:
- Baseline hs-cTnI is a significant predictor of mortality in COVID-19 patients.
- A hs-cTnI threshold of < 5 ng/L effectively identifies low-risk individuals.
- Myocardial injury assessment aids in risk stratification for COVID-19.
Background:
The spectrum of Coronavirus Disease 2019 (COVID-19) is broad and thus early appropriate risk stratification can be helpful. Our objectives were to define the frequency of myocardial injury using high-sensitivity cardiac troponin I (hs-cTnI) and to understand how to use its prognostic abilities.
Methods:
Retrospective study of patients with COVID-19 presenting to an Emergency Department (ED) in Italy in 2020. Hs-cTnI was sampled based on clinical judgment. Myocardial injury was defined as values above the sex-specific 99th percentile upper reference limits (URLs). Most data is from the initial hospital value.
Results:
426 unique patients were included. Hs-cTnI was measured in 313 (73.5%) patients; 85 (27.2%) had myocardial injury at baseline. Patients with myocardial injury had higher mortality during hospitalization (hazard ratio = 9 [95% confidence interval (CI) 4.55-17.79], p < 0.0001). Multivariable analysis including clinical and laboratory variables demonstrated an AUC of 0.942 with modest additional value of hs-cTnI. Myocardial injury was associated with mortality in patients with low APACHE II scores (<13) [OR (95% CI): 4.15 (1.40, 14.22), p = 0.014] but not in those with scores > 13 [OR (95% CI): 0.48 (0.08, 2.65), p = 0.40]. Initial hs-cTnI < 5 ng/L identified 33% of patients that were at low risk with 97.8% sensitivity (95% CI 88.7, 99.6) and 99.2% negative predictive value. Type 1 myocardial infarction (MI) and type 2 MI were infrequent.
Conclusions:
hs-cTnI at baseline is a significant predictor of mortality in COVID-19 patients. A value < 5 ng/L identified patients at low risk.
