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Serial high sensitivity troponin sampling in patients with SARS-CoV-2 infection
Ronstan Lobo1, Laura De Michieli2, Grant M Spears3
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
Insights
Serial cardiac troponin (cTn) measurements in COVID-19 patients reveal that rising levels indicate a higher risk of death. This finding highlights the prognostic value of tracking cTn changes over time for better patient risk stratification.
Area of Science:
- Cardiology
- Infectious Diseases
- Biomarkers
Background:
- Cardiac troponin (cTn) is studied for COVID-19 risk stratification.
- Existing studies often lack analysis of cTn changes over time.
- Serial measurements may offer deeper prognostic insights.
Purpose of the Study:
- To evaluate the prognostic significance of serial cardiac troponin measurements.
- To assess cTn changes in hospitalized COVID-19 patients.
- To determine if serial cTn data improves risk stratification.
Main Methods:
- Retrospective analysis of 228 hospitalized COVID-19 patients (April 2020-March 2021).
- Utilized stored blood samples for high-sensitivity troponin T (hs-cTnT) and troponin I (hs-cTnI) assays.
- Analyzed troponin levels and their trends (increasing, decreasing, stable).
Main Results:
- Myocardial injury, indicated by elevated hs-cTnT or hs-cTnI, significantly increased odds of death (OR > 7).
- An increasing troponin pattern correlated with higher mortality risk compared to stable levels (OR > 4.4).
- Among patients with myocardial injury, an increasing hs-cTnT pattern showed higher mortality odds than a decreasing pattern (OR = 4.80).
Conclusions:
- Myocardial injury in COVID-19 patients is associated with increased mortality.
- Serial hs-cTn testing provides valuable prognostic information beyond single measurements.
- Tracking troponin trends aids in risk stratification for hospitalized COVID-19 patients.
Introduction:
Multiple studies have investigated the role of cardiac troponin (cTn) in the risk stratification of patients with COVID-19. Most of these investigations are based on cTn values at presentation and do not consider the prognostic significance of cTn changes over time. This study aimed to investigate the prognostic role of serial cTn measurements in patients hospitalized with COVID-19 with samples that were not obtained for clinical indications.
Methods:
Patients hospitalized between April 2020 and March 2021 with PCR-confirmed SARS-CoV-2 infection were evaluated. Blood samples collected for any reason were stored for subsequent analysis. If clinical high sensitivity hs-cTnT (Roche) was not measured, samples were tested separately in batches. Hs-cTnI (Abbott) was also evaluated.
Results:
There were 228 unique patients. There were 21 (9.2 %) deaths. No patient with a low hs-cTnT (<6 ng/L) died and 1 patient with low hs-cTnI (<5 ng/L) died. Myocardial injury was associated with higher odds of death, when defined by hs-cTnT (OR: 7.88, 95 % CI: 2.04-30.40, p = 0.003) or hs-cTnI (OR: 7.46, 95 % CI: 2.68-20.77, p < 0.001). This association remained after propensity weighting. An increasing pattern was associated with higher odds of death compared to a stable pattern for hs-cTnT (OR: 5.45, 95 % CI: 1.81-16.40, p = 0.003) and hs-cTnI (OR: 4.49, 95 % CI: 1.02-19.81, p = 0.048). Among patients with myocardial injury defined by hs-cTnT, an increasing pattern was associated with higher odds of death compared to a decreasing pattern (OR: 4.80, 95 % CI: 1.16-19.97, p = 0.031).
Conclusions:
Patients hospitalized with COVID-19 with myocardial injury have higher odds of death. Serial hs-cTn testing provides additional risk stratification in these patients.
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