High sensitivity troponin and COVID-19 outcomes
Nikolaos Papageorgiou1,2, Catrin Sohrabi1, David Prieto Merino3,4
1St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
Insights
Elevated troponin levels in COVID-19 patients indicate myocardial injury and predict adverse outcomes, including increased need for ventilation and higher mortality risk. These findings suggest troponin testing can aid in managing COVID-19 patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Recent studies highlight elevated troponin levels in COVID-19 patients.
- Myocardial injury is a significant concern in COVID-19 pathophysiology.
Purpose of the Study:
- To investigate the association between admission and peak troponin levels and COVID-19 outcomes.
- To determine the predictive value of troponin for adverse events in COVID-19 patients.
Main Methods:
- Observational, multi-ethnic, multi-center study of 434 COVID-19 positive patients in London, UK.
- Data collected during the second half of March 2020.
Main Results:
- Myocardial injury (positive troponin) observed in 66.4% of patients.
- Positive peak troponin levels independently predicted need for ventilation, renal replacement therapy, acute kidney injury, venous thromboembolism, atrial fibrillation, and in-hospital death.
- Patients with elevated troponin had longer hospital stays.
Conclusions:
- Admission and peak troponin levels are significant predictors of cardiovascular and non-cardiovascular outcomes in COVID-19.
- Troponin level assessment can inform patient management strategies for COVID-19.
Background:
Recent reports have demonstrated high troponin levels in patients affected with COVID-19. In the present study, we aimed to determine the association between admission and peak troponin levels and COVID-19 outcomes.
Methods:
This was an observational multi-ethnic multi-centre study in a UK cohort of 434 patients admitted and diagnosed COVID-19 positive, across six hospitals in London, UK during the second half of March 2020.
Results:
Myocardial injury, defined as positive troponin during admission was observed in 288 (66.4%) patients. Age (OR: 1.68 [1.49-1.88], p < .001), hypertension (OR: 1.81 [1.10-2.99], p = .020) and moderate chronic kidney disease (OR: 9.12 [95% CI: 4.24-19.64], p < .001) independently predicted myocardial injury. After adjustment, patients with positive peak troponin were more likely to need non-invasive and mechanical ventilation (OR: 2.40 [95% CI: 1.27-4.56], p = .007, and OR: 6.81 [95% CI: 3.40-13.62], p < .001, respectively) and urgent renal replacement therapy (OR: 4.14 [95% CI: 1.34-12.78], p = .013). With regards to events, and after adjustment, positive peak troponin levels were independently associated with acute kidney injury (OR: 6.76 [95% CI: 3.40-13.47], p < .001), venous thromboembolism (OR: 11.99 [95% CI: 3.20-44.88], p < .001), development of atrial fibrillation (OR: 10.66 [95% CI: 1.33-85.32], p = .026) and death during admission (OR: 2.40 [95% CI: 1.34-4.29], p = .003). Similar associations were observed for admission troponin. In addition, median length of stay in days was shorter for patients with negative troponin levels: 8 (5-13) negative, 14 (7-23) low-positive levels and 16 (10-23) high-positive (p < .001).
Conclusions:
Admission and peak troponin appear to be predictors for cardiovascular and non-cardiovascular events and outcomes in COVID-19 patients, and their utilisation may have an impact on patient management.
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