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Multicenter Study
. 2020 Nov 1;5(11):1274-1280.
doi: 10.1001/jamacardio.2020.3538.

Association of Troponin Levels With Mortality in Italian Patients Hospitalized With Coronavirus Disease 2019: Results of a Multicenter Study

Carlo Mario Lombardi  1 , Valentina Carubelli  1 , Annamaria Iorio  2 , Riccardo M Inciardi  1 , Antonio Bellasi  3 , Claudia Canale  4 , Rita Camporotondo  5 , Francesco Catagnano  6 , Laura A Dalla Vecchia  7 , Stefano Giovinazzo  4 , Gloria Maccagni  1   8 , Massimo Mapelli  9   10 , Davide Margonato  6   11 , Luca Monzo  12   13 , Vincenzo Nuzzi  14 , Chiara Oriecuia  15   16 , Giulia Peveri  10   15 , Andrea Pozzi  2 , Giovanni Provenzale  17 , Filippo Sarullo  18 , Daniela Tomasoni  1 , Pietro Ameri  4 , Massimiliano Gnecchi  5   19 , Sergio Leonardi  5   19 , Marco Merlo  14 , Piergiuseppe Agostoni  9   10 , Stefano Carugo  17 , Gian Battista Danzi  8 , Marco Guazzi  20   21 , Maria Teresa La Rovere  22 , Andrea Mortara  6 , Massimo Piepoli  23   24 , Italo Porto  4 , Gianfranco Sinagra  14 , Maurizio Volterrani  25 , Claudia Specchia  15 , Marco Metra  1 , Michele Senni  2
Affiliations
Multicenter Study

Association of Troponin Levels With Mortality in Italian Patients Hospitalized With Coronavirus Disease 2019: Results of a Multicenter Study

Carlo Mario Lombardi et al. JAMA Cardiol. .

Abstract

Importance: Myocardial injury, detected by elevated plasma troponin levels, has been associated with mortality in patients hospitalized with coronavirus disease 2019 (COVID-19). However, the initial data were reported from single-center or 2-center studies in Chinese populations. Compared with these patients, European and US patients are older, with more comorbidities and higher mortality rates.

Objective: To evaluate the prevalence and prognostic value of myocardial injury, detected by elevated plasma troponin levels, in a large population of White Italian patients with COVID-19.

Design, setting, and participants: This is a multicenter, cross-sectional study enrolling consecutive patients with laboratory-confirmed COVID-19 who were hospitalized in 13 Italian cardiology units from March 1 to April 9, 2020. Patients admitted for acute coronary syndrome were excluded. Elevated troponin levels were defined as values greater than the 99th percentile of normal values.

Main outcomes and measures: Clinical characteristics and outcomes stratified as elevated or normal cardiac troponin levels at admission, defined as troponin T or troponin I at a level greater than the 99th percentile of normal values.

Results: A total of 614 patients with COVID-19 were included in this study (mean age [SD], 67 [13] years; 70.8% male), of whom 148 patients (24.1%) died during the hospitalization. Elevated troponin levels were found in 278 patients (45.3%). These patients were older (mean [SD] age, 64.0 [13.6] years vs 71.3 [12.0] years; P < .001) and had higher prevalence of hypertension (168 patients [50.5%] vs 182 patients [65.9%]; P < .001), heart failure (24 [7.2%]; 63 [22.8%]; P < .001), coronary artery disease (50 [15.0%] vs 87 [31.5%]; P < .001), and atrial fibrillation (33 [9.9%] vs 67 [24.3%]; P < .001). Elevated troponin levels were associated with an increased in-hospital mortality (37% vs 13%; HR, 1.71 [95% CI, 1.13-2.59]; P = .01 via multivariable Cox regression analysis), and this was independent from concomitant cardiac disease. Elevated troponin levels were also associated with a higher risk of in-hospital complications: heart failure (44 patients [19.2%] vs 7 patients [2.9%]; P < .001), sepsis (31 [11.7%] vs 21 [6.4%]; P = .03), acute kidney failure (41 [20.8%] vs 13 [6.2%]; P < .001), multiorgan failure (21 [10.9%] vs 6 [2.9%]; P = .003), pulmonary embolism (27 [9.9%] vs 17 [5.2%]; P = .04), delirium (13 [6.8%] vs 3 [1.5%]; P = .02), and major bleeding (16 [7.0%] vs 4 [1.6%]; P = .008).

Conclusions and relevance: In this multicenter, cross-sectional study of Italian patients with COVID-19, elevated troponin was an independent variable associated with in-hospital mortality and a greater risk of cardiovascular and noncardiovascular complications during a hospitalization for COVID-19.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Carubelli received consulting honoraria from CVie Therapeutics Limited, Servier, and Windtree Therapeutics outside the submitted work. Dr Ameri reported having received speaker and advisor honoraria from Novartis, AstraZeneca, Vifor, Daiichi Sankyo, Boehringer Ingelheim, Pfizer, GlaxoSmithKline, and Merck, Sharp & Dohme and nonfinancial support from Actelion outside the submitted work. Dr Leonardi reported grants and personal fees from AstraZeneca and personal fees from BMS/Pfizer, Novo Nordisk, and Chiesi outside the submitted work. Dr Agostoni reported nonfinancial support from Menarini, Novartis, and Boehringer; grants from Daiichi Sankyo and Bayer; and grants and nonfinancial support from Actelion outside the submitted work. Dr Mortara reports personal consulting honoraria from Novartis, Servier, Astra Zeneca for participation to advisory board meetings and receives grants from Novartis and Niccomo for research trials. Dr Piepoli reported having received research grants and speaking fees from Novartis, Servier, and TRX and nonfinancial support from Vifor outside the submitted work. Dr Metra reported personal consulting honoraria from Abbott Vascular, Amgen, Bayer, Edwards Therapeutics, Servier, Vifor Pharma, and Windtree Therapeutics for participation to advisory board meetings and executive committees of clinical trials. Dr Senni reported personal fees from Novartis, Abbott, Merck, Bayer, Boehringer, Vifor, and AstraZeneca outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Cumulative Incidence of Death During Hospitalization Stratified by Baseline Troponin Level (N = 614)
Figure 2.
Figure 2.. Cumulative Incidence of Death During Hospitalization Stratified by Baseline Troponin Level and Histories of Heart Failure (HF) (A), Coronary Artery Disease (CAD) (B), Atrial Fibrillation (AF) (C) (n = 609)
Tn indicates troponin.
See this image and copyright information in PMC

References

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