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Observational Study
. 2021 Jan 1:138:100-106.
doi: 10.1016/j.amjcard.2020.09.060. Epub 2020 Oct 13.

Usefulness of Elevated Troponin to Predict Death in Patients With COVID-19 and Myocardial Injury

David T Majure  1 , Luis Gruberg  2 , Shahryar G Saba  3 , Charlotte Kvasnovsky  4 , Jamie S Hirsch  5 , Rajiv Jauhar  3 ; Northwell Health COVID-19 Research Consortium
Affiliations
Observational Study

Usefulness of Elevated Troponin to Predict Death in Patients With COVID-19 and Myocardial Injury

David T Majure et al. Am J Cardiol. .

Abstract

Elevations in troponin levels have been shown to predict mortality in patients with coronavirus disease 2019 (COVID-19). The role of inflammation in myocardial injury remains unclear. We sought to determine the association of elevated troponin with mortality in a large, ethnically diverse population of patients hospitalized with COVID-19, and to determine the association of elevated inflammatory markers with increased troponin levels. We reviewed all patients admitted at our health system with COVID-19 from March 1 to April 27, 2020, who had a troponin assessment within 48 hours of admission. We used logistic regression to calculate odds ratios (ORs) for mortality during hospitalization, controlling for demographics, co-morbidities, and markers of inflammation. Of 11,159 patients hospitalized with COVID-19, 6,247 had a troponin assessment within 48 hours. Of these, 4,426 (71%) patients had normal, 919 (15%) had mildly elevated, and 902 (14%) had severely elevated troponin. Acute phase and inflammatory markers were significantly elevated in patients with mildly and severely elevated troponin compared with normal troponin. Patients with elevated troponin had significantly increased odds of death for mildly elevated compared with normal troponin (adjusted OR, 2.06; 95% confidence interval, 1.68 to 2.53; p < 0.001) and for severely elevated compared with normal troponin (OR, 4.51; 95% confidence interval, 3.66 to 5.54; p < 0.001) independently of elevation in inflammatory markers. In conclusion, patients hospitalized with COVID-19 and elevated troponin had markedly increased mortality compared with patients with normal troponin levels. This risk was independent of cardiovascular co-morbidities and elevated markers of inflammation.

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Figures

Figure 1
Figure 1
Flow diagram of patients admitted with COVID-19 and assessment of troponin.
Figure 2
Figure 2
Forest plot of odds ratio of death in patients admitted with COVID-19. ACE-I = angiotensin converting enzyme inhibitor; ARB = angiotensin receptor blocker; CI = confidence interval; COPD, chronic obstructive pulmonary disease; OR = odds ratio; URL = upper reference limit.
Figure 3
Figure 3
Forest plot of adjusted odds of mortality by troponin elevation stratified by troponin assay type. TnI = Troponin I; TnT = Troponin T; HS-TnT = high-sensitivity Troponin T; and URL = upper reference limit.
See this image and copyright information in PMC

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