Negative Troponin I as a Predictor of Survival in Patients With Coronavirus Disease 2019
Fergie J Losiniecki1, Jose Lopez2, Majd Jazaerly3
1Division of Electrophysiology, Medical University of South Carolina, Charleston, SC, United States.
Insights
A normal troponin I level within 24 hours of admission for Coronavirus Disease 2019 (COVID-19) is associated with lower in-hospital mortality and fewer cardiac complications. This finding suggests a negative troponin I may indicate a less severe hospital course for COVID-19 patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Limited data exists on the prognostic value of normal troponin I levels in Coronavirus Disease 2019 (COVID-19) patients.
- Troponin I is a biomarker for cardiac injury, but its role in risk stratification for COVID-19 requires further investigation.
Purpose of the Study:
- To evaluate the utility and negative predictive value of serum troponin I levels for predicting in-hospital mortality in COVID-19 patients.
- To determine if a normal troponin I level within the first 24 hours of admission can identify patients with a more benign clinical course.
Main Methods:
- Retrospective analysis of 65,580 adult COVID-19 patients admitted between March 2020 and March 2021.
- Patients were stratified based on troponin I levels (elevated vs. negative) within 24 hours of admission.
- Odds ratios (OR) and 95% confidence intervals (CI) were calculated to assess associations with mortality and complications.
Main Results:
- A negative troponin I value was significantly associated with reduced odds of in-hospital death (OR = 0.32) and cardiac complications (OR = 0.38).
- The negative predictive value of a normal troponin I for all-cause in-hospital mortality was 85.7%.
- No significant difference in hospital length of stay was observed between groups.
Conclusions:
- A normal troponin I level in the first 24 hours of admission is a significant indicator of decreased mortality risk in COVID-19 patients.
- The absence of troponin I elevation may predict a more favorable hospital outcome.
- Normal troponin I levels can aid in risk stratification for COVID-19 patients.
Background:
Despite a large amount of evidence evaluating elevated troponin I levels and adverse clinical outcomes, little is known about the role of a normal (negative) troponin I during the first 24 h of admission for risk stratification in patients with Coronavirus Disease 2019 (COVID-19). This study aims to evaluate the utility and negative predictive value of a serum troponin I level to predict in-hospital mortality.
Methods:
We retrospectively analyzed all adult patients (>18 years of age) with COVID-19 admitted to an HCA Healthcare facility between March 2020 and March 2021 who had a troponin I level drawn at admission. Patients were initially stratified into two groups based on their cardiac troponin I value in the first 24 h of admission (elevated vs negative).
Results:
A total of 65,580 patients were included in the final analysis. A negative troponin I value was associated with lesser odds of death during admission (OR = 0.32, 95 % CI 0.31-0.34, p < 0.01) and cardiac complications (OR = 0.38, 95 % CI 0.37-0.40, p < 0.01). The negative predictive value of a negative troponin value for all-cause in-hospital mortality was 85.7 %.
Conclusions:
Our study found a significant association between a negative troponin I value in the first 24 h of admission and decreased odds of death during admission in patients with confirmed COVID-19 infection, in addition to decreased odds of cardiac complications but no significant difference in hospital length of stay. Therefore, the authors suggest that the absence of troponin I elevation may serve as an indicator of a more benign hospital course.
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
01:30Acute Coronary Syndrome I: Introduction
01:27Myocarditis II: Clinical Features and Diagnostic Tests
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
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...