Elevated High Sensitivity Cardiac Troponin T is Nonlinearly Associated with Poor Prognosis in Aging COVID-19
Xiaxia Jin1, Haideng Yang2, Weiwei Ma1
1Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, People's Republic of China.
Insights
High-sensitivity cardiac troponin T (hs-cTnT) levels predict death and major adverse events in elderly COVID-19 patients. The risk increases non-linearly with hs-cTnT, highlighting its prognostic value.
Area of Science:
- Cardiology
- Infectious Diseases
- Geriatrics
Background:
- Coronavirus disease 2019 (COVID-19) poses significant risks to elderly populations.
- Cardiac biomarkers, such as high-sensitivity cardiac troponin T (hs-cTnT), are crucial for assessing cardiac injury and prognosis.
Purpose of the Study:
- To evaluate the prognostic value of hs-cTnT in elderly patients diagnosed with COVID-19.
- To determine the relationship between hs-cTnT levels and in-hospital mortality and major adverse events.
Main Methods:
- A cohort of 1399 elderly COVID-19 patients (≥65 years) was analyzed.
- Cox and logistic regression models assessed the association between hs-cTnT and outcomes.
- Restricted cubic spline (RCS) models were employed for nonlinear association analysis.
Main Results:
- Elevated peak hs-cTnT levels significantly correlated with increased risk of death (HR 9.49) and major adverse events (OR 20.59).
- Nonlinear analysis revealed a steep, S-shaped increase in risk from 3 ng/L hs-cTnT, plateauing around 131 ng/L.
- Peak hs-cTnT demonstrated strong predictive value for in-hospital death (AUC 0.834) and major adverse events (AUC 0.804).
Conclusions:
- Peak hs-cTnT is a potent predictor of in-hospital mortality and major adverse events in elderly COVID-19 patients.
- The association between peak hs-cTnT and adverse outcomes is nonlinear, with risk escalating significantly at lower levels.
Objective:
To evaluate the relationship between high-sensitivity cardiac troponin T (hs-cTnT) and prognosis in elderly patients with coronavirus disease 2019 (COVID-19).
Methods:
This study recruited 1399 COVID-19 patients aged 65 years or older admitted to Taizhou Hospital or Enze Hospital in Zhejiang Province from December 15, 2022, to January 4, 2023. The Cox regression model was used to evaluate the relationship between hs-cTnT level and in-hospital death. The logistic regression model was used to evaluate the relationship between hs-cTnT level and major adverse events. The restricted cubic spline (RCS) model is used for nonlinear analysis.
Results:
The increase of peak hs-cTnT was associated with the increased risk of death (HR 9.49; 95% CI 1.19-75.48; trend p = 0.012) and major adverse events (OR 20.59; 95% CI 10.41-40.71; trend p < 0.001). RCS model showed the association between peak hs-cTnT and death and major adverse events were nonlinear (P for non-line < 0.001). Starting from the limit of quantification of hs-cTnT (3ng/L), the risk of death and major adverse events had a steep S-shaped increase until hs-cTnT reached the 90th percentile point (hs-cTnT = 131 ng/L), followed by a plateau period. Peak hs-cTnT has good predictive value for death and major adverse events, with AUC of 0.834 and 0.804, respectively.
Conclusion:
Peak hs-cTnT has high predictive value for the risk of in-hospital death and major adverse events in elderly patients with COVID-19. The association between peak hs-cTnT and death and major adverse events were nonlinear.
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