The prognostic value of serial troponin measurements in patients admitted for COVID-19
Vincenzo Nuzzi1, Marco Merlo1, Claudia Specchia2
1Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Via Valdoni 7, Trieste, 34100, Italy.
Insights
Myocardial injury (MI) in COVID-19 patients can be detected by tracking troponin levels. A second troponin test on Day 2 can identify patients with incident MI who are at high risk of death.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Myocardial injury (MI) is common in COVID-19 patients and impacts prognosis.
- Troponin trajectories and their prognostic significance in COVID-19 remain under-investigated.
Purpose of the Study:
- To investigate the early in-hospital evolution of myocardial injury in COVID-19 patients.
- To determine the prognostic impact of troponin level changes during hospitalization.
Main Methods:
- Analysis of data from a multicenter Italian study of COVID-19 patients hospitalized between March and April 2020.
- Myocardial injury defined by elevated troponin levels (above 99th percentile).
- Troponin levels assessed at admission and between 24-48 hours; patients categorized into four groups based on troponin status.
Main Results:
- Of 197 patients, 44% had elevated troponin at both assessments, 41% had normal levels throughout.
- 25% of patients died during hospitalization.
- Patients with incident MI, persistent MI, or MI at admission had significantly higher mortality risk (P < 0.001).
- Normal troponin at admission with MI on Day 2 indicated the highest mortality risk (HR 3.78).
Conclusions:
- Serial troponin testing on Day 2 in COVID-19 patients provides significant prognostic value.
- A subset of patients with incident MI on Day 2 are identified as high risk solely by the second measurement.
Aims:
Myocardial injury (MI) in coronavirus disease-19 (COVID-19) is quite prevalent at admission and affects prognosis. Little is known about troponin trajectories and their prognostic role. We aimed to describe the early in-hospital evolution of MI and its prognostic impact.
Methods And Results:
We performed an analysis from an Italian multicentre study enrolling COVID-19 patients, hospitalized from 1 March to 9 April 2020. MI was defined as increased troponin level. The first troponin was tested within 24 h from admission, the second one between 24 and 48 h. Elevated troponin was defined as values above the 99th percentile of normal values. Patients were divided in four groups: normal, normal then elevated, elevated then normal, and elevated. The outcome was in-hospital death. The study population included 197 patients; 41% had normal troponin at both evaluations, 44% had elevated troponin at both assessments, 8% had normal then elevated troponin, and 7% had elevated then normal troponin. During hospitalization, 49 (25%) patients died. Patients with incident MI, with persistent MI, and with MI only at admission had a higher risk of death compared with those with normal troponin at both evaluations (P < 0.001). At multivariable analysis, patients with normal troponin at admission and MI injury on Day 2 had the highest mortality risk (hazard ratio 3.78, 95% confidence interval 1.10-13.09, P = 0.035).
Conclusions:
In patients admitted for COVID-19, re-test MI on Day 2 provides a prognostic value. A non-negligible proportion of patients with incident MI on Day 2 is identified at high risk of death only by the second measurement.
More Related Videos
04:41Digital PCR for Quantifying Circulating MicroRNAs in Acute Myocardial Infarction and Cardiovascular Disease
Published on: July 3, 2018
18:11A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
Published on: December 28, 2012
Related Concept Videos
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:27Myocarditis II: Clinical Features and Diagnostic Tests
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:19Pericarditis II: Clinical Features and Diagnostic Tests