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. 2020 Dec 17;9(12):4078.
doi: 10.3390/jcm9124078.

Prognostic Value of Troponin Elevation in COVID-19 Hospitalized Patients

Elena-Mihaela Cordeanu  1 , Nicolas Duthil  1 , Francois Severac  2 , Hélène Lambach  1 , Jonathan Tousch  1 , Lucas Jambert  3 , Corina Mirea  1 , Alexandre Delatte  4 , Waël Younes  5 , Anne-Sophie Frantz  1 , Hamid Merdji  6 , Valérie Schini-Kerth  7 , Pascal Bilbault  8 , Patrick Ohlmann  9 , Emmanuel Andres  10 , Dominique Stephan  1
Affiliations

Prognostic Value of Troponin Elevation in COVID-19 Hospitalized Patients

Elena-Mihaela Cordeanu et al. J Clin Med. .

Abstract

(1) Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) penetrates the respiratory epithelium through angiotensin-converting enzyme-2 (ACE2) binding. Myocardial and endothelial expression of ACE2 could account for the growing body of reported evidence of myocardial injury in severe forms of Human Coronavirus Disease 2019 (COVID-19). We aimed to provide insight into the impact of troponin (hsTnI) elevation on SARS-CoV-2 outcomes in patients hospitalized for COVID-19. (2) Methods: This was a retrospective analysis of hospitalized adult patients with the SARS-CoV-2 infection admitted to a university hospital in France. The observation period ended at hospital discharge. (3) Results: During the study period, 772 adult, symptomatic COVID-19 patients were hospitalized for more than 24 h in our institution, of whom 375 had a hsTnI measurement and were included in this analysis. The median age was 66 (55-74) years, and there were 67% of men. Overall, 205 (55%) patients were placed under mechanical ventilation and 90 (24%) died. A rise in hsTnI was noted in 34% of the cohort, whereas only three patients had acute coronary syndrome (ACS) and one case of myocarditis. Death occurred more frequently in patients with hsTnI elevation (HR 3.95, 95% CI 2.69-5.71). In the multivariate regression model, a rise in hsTnI was independently associated with mortality (OR 3.12, 95% CI 1.49-6.65) as well as age ≥ 65 years old (OR 3.17, 95% CI 1.45-7.18) and CRP ≥ 100 mg/L (OR 3.62, 95% CI 1.12-13.98). After performing a sensitivity analysis for the missing values of hsTnI, troponin elevation remained independently and significantly associated with death (OR 3.84, 95% CI 1.78-8.28). (4) Conclusion: Our study showed a four-fold increased risk of death in the case of a rise in hsTnI, underlining the prognostic value of troponin assessment in the COVID-19 context.

Keywords: COVID-19; SARS-CoV-2; biomarker; cardiovascular; myocardial injury; troponin.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study flowchart showing patient selection. COVID-19: Human Coronavirus Disease 2019; Feb: February; h: hours; hs: high-sensitivity; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2.
Figure 2
Figure 2
Crude survival rates according to high-sensitivity troponin levels. CI: confidence interval; HR: hazard ratio; hsTnI: high-sensitivity troponin I.
See this image and copyright information in PMC

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