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Measuring High-sensitive Cardiac Troponin Concentrations Predicted Hospital Deaths in Children With Severe
Yan Li1, Aiqin Song1, Sainan Sun1,2
1From the Department of Pediatric Intensive Care Unit, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
Insights
High-sensitive cardiac troponin T (hs-cTnT) effectively predicts in-hospital mortality in children with severe COVID-19. An hs-cTnT level of 0.09 ng/mL is the optimal cutoff for predicting mortality risk.
Area of Science:
- Cardiology
- Pediatric Infectious Diseases
- Critical Care Medicine
Background:
- Despite advancements in antiviral drugs and vaccines, coronavirus disease 2019 (COVID-19) remains a significant mortality risk for children.
- Myocardial cell damage, indicated by elevated high-sensitive cardiac troponin T (hs-cTnT), occurs following SARS-CoV-2 infection.
- Pediatric COVID-19 patients face a substantial risk of severe outcomes and mortality.
Purpose of the Study:
- To evaluate the predictive capability of hs-cTnT levels for in-hospital mortality in pediatric patients with severe COVID-19.
- To determine the optimal hs-cTnT cutoff value for predicting mortality in this population.
Main Methods:
- A cohort of severely ill pediatric COVID-19 patients was analyzed between December 2021 and January 2022.
- Clinical data, including hs-cTnT, alanine aminotransferase, and creatinine levels, were recorded.
- Cox regression analyses were performed to assess the association between biomarkers and mortality.
Main Results:
- A significant association was found between hs-cTnT levels and in-hospital mortality in pediatric COVID-19 patients (Hazard Ratio: 14.835; P < 0.001).
- The optimal hs-cTnT cutoff for predicting in-hospital mortality was determined to be 0.09 ng/mL.
- This cutoff demonstrated high accuracy, with an area under the curve of 0.989, 100% sensitivity, and 96.1% specificity.
Conclusions:
- Elevated hs-cTnT levels serve as an independent biomarker for predicting in-hospital mortality in critically ill children with COVID-19.
- An hs-cTnT cutoff of 0.09 ng/mL is recommended for risk stratification in pediatric COVID-19 cases.
Background:
Antiviral drugs and coronavirus disease 2019 (COVID-19) vaccines have significantly reduced COVID-19-related hospitalizations and deaths in infected children. However, COVID-19 continues to pose a major mortality risk in young children. High-sensitive cardiac troponin (Hs-cTn) is a specific marker of myocardial cell damage. After infection with the novel coronavirus, myocardial cells are damaged, and high-sensitive troponin will increase. In this study, we aimed to evaluate the predictive power of hs-cTnT for in-hospital mortality in pediatric COVID-19 patients.
Methods:
In this study, which was conducted between December 2021 and January 2022, we included severely ill pediatric COVID-19 patients. We recorded their clinical data. Then, the association of hs-cTnT levels with mortality and of alanine aminotransferase and creatinine levels with mortality was analyzed.
Results:
For the 119 children (70 males and 49 females) with severe COVID-19 included, the findings of univariate and multivariable Cox regression analyses revealed a significant association between hs-cTnT and in-hospital mortality (hazard ratio: 14.835; 95% confidence interval: 6.051-36.373; P < 0.001). The cutoff level of hs-cTnT to accurately predict in-hospital mortality was 0.09 ng/mL (area under the curve: 0.989; sensitivity: 1.000; specificity: 0.961; Youden index: 0.961).
Conclusion:
In severely ill children with COVID-19 infection, hs-cTnT can be used as an independent biomarker to predict in-hospital mortality. The optimum cutoff was 0.09 ng/mL.
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