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. 2021 Apr:90:8-14.
doi: 10.1016/j.clinbiochem.2021.01.006. Epub 2021 Jan 30.

Using high sensitivity cardiac troponin values in patients with SARS-CoV-2 infection (COVID-19): The Padova experience

Laura De Michieli  1 , Luciano Babuin  2 , Stefania Vigolo  3 , Giulia Berti De Marinis  3 , Alessandro Lunardon  3 , Francesco Favretto  3 , Ronstan Lobo  4 , Yader Sandoval  4 , Sandra C Bryant  5 , Daniele Donato  6 , Mario Plebani  7 , Roberto Vettor  8 , Sabino Iliceto  2 , Vito Cianci  3 , Allan S Jaffe  9
Affiliations

Using high sensitivity cardiac troponin values in patients with SARS-CoV-2 infection (COVID-19): The Padova experience

Laura De Michieli et al. Clin Biochem. 2021 Apr.

Abstract

Background: The spectrum of Coronavirus Disease 2019 (COVID-19) is broad and thus early appropriate risk stratification can be helpful. Our objectives were to define the frequency of myocardial injury using high-sensitivity cardiac troponin I (hs-cTnI) and to understand how to use its prognostic abilities.

Methods: Retrospective study of patients with COVID-19 presenting to an Emergency Department (ED) in Italy in 2020. Hs-cTnI was sampled based on clinical judgment. Myocardial injury was defined as values above the sex-specific 99th percentile upper reference limits (URLs). Most data is from the initial hospital value.

Results: 426 unique patients were included. Hs-cTnI was measured in 313 (73.5%) patients; 85 (27.2%) had myocardial injury at baseline. Patients with myocardial injury had higher mortality during hospitalization (hazard ratio = 9 [95% confidence interval (CI) 4.55-17.79], p < 0.0001). Multivariable analysis including clinical and laboratory variables demonstrated an AUC of 0.942 with modest additional value of hs-cTnI. Myocardial injury was associated with mortality in patients with low APACHE II scores (<13) [OR (95% CI): 4.15 (1.40, 14.22), p = 0.014] but not in those with scores > 13 [OR (95% CI): 0.48 (0.08, 2.65), p = 0.40]. Initial hs-cTnI < 5 ng/L identified 33% of patients that were at low risk with 97.8% sensitivity (95% CI 88.7, 99.6) and 99.2% negative predictive value. Type 1 myocardial infarction (MI) and type 2 MI were infrequent.

Conclusions: hs-cTnI at baseline is a significant predictor of mortality in COVID-19 patients. A value < 5 ng/L identified patients at low risk.

Keywords: COVID-19; High-sensitivity cardiac troponin I; Myocardial injury; Outcomes; Risk stratification; SARS-CoV-2.

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Conflict of interest statement

Dr. Jaffe presently or in the past has consulted for most of the major diagnostic companies. Dr. Sandoval has participated as an advisory board/speaker for Abbott Diagnostics without personal financial compensation and on the advisory board (past) for Roche Diagnostics without personal financial compensation. All the other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Kaplan-Meier survival curves for mortality during index hospitalization for patients without and with myocardial injury at baseline hs-cTnI sample. Abbreviations: HR: hazard ratio; CI, confidence interval.
Fig. 2
Fig. 2
Receiver operating characteristic (ROC) curve for the multivariable propensity inverse probability model for mortality including hypertension and diabetes, structural heart disease, chronic kidney disease, age, APACHE II score, C-reactive protein and hs-cTnI.
See this image and copyright information in PMC

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