Clinical Impact and Predictors of Troponin Elevation in Patients With COVID-19
Brian C Case1, Charan Yerasi1, Brian J Forrestal1
1Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
Insights
Significant troponin elevation in patients with coronavirus disease 2019 (COVID-19) indicates a higher risk of mechanical ventilation and mortality. Early recognition and intensive care are crucial for improving outcomes in these high-risk COVID-19 patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Cardiac involvement, indicated by troponin elevation, is a known complication of coronavirus disease 2019 (COVID-19).
- Initial studies suggested a worse prognosis for COVID-19 patients with myocardial injury compared to those without.
- The clinical impact and predictors of poor outcomes in COVID-19 patients with significant troponin elevation require further evaluation throughout the pandemic.
Purpose of the Study:
- To evaluate the clinical impact of significant troponin elevation in COVID-19 positive patients.
- To identify predictors of poor outcomes, including mortality, in this patient group.
- To assess the association between troponin elevation and the need for mechanical ventilation.
Main Methods:
- Analysis of COVID-19 positive admitted patients within the MedStar Health system from March 1 to June 30, 2020.
- Comparison of clinical course and outcomes between patients with and without troponin elevation (≥1.0 ng/mL).
- Identification of predictors for in-hospital mortality.
Main Results:
- A cohort of 2716 COVID-19 patients had troponin levels drawn; 250 (9.2%) had troponin elevation.
- Patients with troponin elevation were older, had more comorbidities, and were more likely to require mechanical ventilation.
- In-hospital mortality was significantly higher in COVID-19 patients with troponin elevation (48.4%) compared to those without (12.2%; p < 0.001).
Conclusions:
- COVID-19 patients with troponin elevation face a substantially increased risk of requiring mechanical ventilation and experiencing mortality.
- Early recognition, thorough evaluation, and intensified care strategies are essential for managing COVID-19 patients with troponin elevation.
- Troponin elevation serves as a critical indicator of poor prognosis in COVID-19 patients.
Background:
Cardiac involvement in coronavirus disease 2019 (COVID-19) is known, manifested by troponin elevation. Studies in the initial phase of the pandemic demonstrated that these patients tended to have a worse prognosis than patients without myocardial injury. We sought to evaluate the clinical impact of significant troponin elevation in COVID-19-positive patients, along with predictors of poor outcomes, over the span of the pandemic to date.
Methods:
We analyzed COVID-19-positive patients who presented to the MedStar Health system (11 hospitals in Washington, DC, and Maryland) during the pandemic (March 1-June 30, 2020). We compared clinical course and outcomes based on the presence of troponin elevation and identified predictors of mortality.
Results:
The cohort included 2716 COVID-19-positive admitted patients for whom troponin was drawn. Of these patients, 250 had troponin elevation (≥1.0 ng/mL). In the troponin-elevation arm, the minimum troponin level was 1.9 ± 8.82 ng/mL; maximum elevation was 10.23 ± 31.07 ng/mL. The cohort's mean age was 68.0 ± 15.0 years; 52.8% were men. Most (68.5%) COVID-19-positive patients with troponin elevation were African American. Patients with troponin elevation tended to be older, with more co-morbidities, and most required mechanical ventilation. In-hospital mortality was significantly higher (48.4%) in COVID-19-positive patients with concomitant troponin elevation than without troponin elevation (12.2%; p < 0.001).
Conclusion:
COVID-19 patients with troponin elevation are at higher risk for mechanical ventilation and mortality. Efforts should focus on early recognition, evaluation, and intensifying care of these patients.
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