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Multicenter Study
. 2021 May 15:147:129-136.
doi: 10.1016/j.amjcard.2021.01.037. Epub 2021 Feb 20.

Impact and Determinants of High-Sensitivity Cardiac Troponin-T Concentration in Patients With COVID-19 Admitted to Critical Care

Ozan M Demir  1 , Matthew Ryan  1 , Chiara Cirillo  2 , Nishita Desai  3 , Ana Pericao  3 , Hannah Sinclair  3 , Vasileios Stylianidis  3 , Kelly Victor  3 , Bashir Alaour  1 , Andrew Jones  3 , Antonis N Pavlidis  3 , Andrew Retter  3 , Gerald Carr-White  4 , Luigi Camporota  3 , Nicholas Barrett  3 , Michael Marber  1 , Divaka Perera  5
Affiliations
Multicenter Study

Impact and Determinants of High-Sensitivity Cardiac Troponin-T Concentration in Patients With COVID-19 Admitted to Critical Care

Ozan M Demir et al. Am J Cardiol. .

Abstract

Cardiac Troponin (hs-TnT) elevation has been reported in unselected patients hospitalized with COVID-19 however the mechanism and relationship with mortality remain unclear. Consecutive patients admitted to a high-volume intensive care unit (ICU) in London with severe COVID-19 pneumonitis were included if hs-TnT concentration at admission was known. Kaplan-Meier survival analysis performed, with cohorts classified a priori by multiples of the upper limit of normal (ULN). 277 patients were admitted during a 7-week period in 2020; 176 were included (90% received invasive ventilation). hs-TnT at admission was 16.5 (9.0 to 49.3) ng/L, 56% had concentrations >ULN. 56 patients (31.8%) died during the index admission. Admission hs-TnT level was lower in survivors (12.0 (8.0-27.8) vs 28.5 (14.0 to 81.0) ng/L, p = 0.001). Univariate predictors of mortality were age, APACHE-II Score and admission hs-TnT (HR 1.73, p = 0.007). By multivariate regression, only age (HR 1.33, CI: 1.16.to 1.51, p < 0.01) and admission hs-TnT (HR 1.94, CI: 1.22 to 3.10, p = 0.006) remained predictive. Survival was significantly lower when admission hs-TnT was >ULN (log-rank p-value<0.001). Peak hs-TnT was higher in those who died but was not predictive of death after adjustment for other factors. In conclusion, in critically ill patients with COVID-19 pneumonitis, the hs-TnT level at admission is a powerful independent predictor of the likelihood of surviving to discharge from ICU. In most cases, hs-TnT elevation does not represent major myocardial injury but acts as a sensitive integrated biomarker of global stress. Whether stratification based on admission Troponin level could be used to guide prognostication and management warrants further evaluation.

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Conflict of interest statement

Declaration of Interests The authors declare that they have no known competing financial interests or personal relations that could have appeared to influence the work reported in this study.

Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
Histogram of admission and peak high sensitivity Troponin-T measurements.
Figure 3
Figure 3
Patient characteristics and outcomes by admission high-sensitivity Cardiac Troponin-T. Length of stay (LOS) analysis exclusively of patients who survived to discharge from intensive care unit.
Figure 4
Figure 4
Receiver operating characteristic curve of mortality. Area under the curve (AUC): Hs-TnT 0.71, Age 0.68, APACHE-II score 0.67 and SOFA score 0.60. Optimal cut-off value of hs-TnT to predict mortality was >17 ng/L, at a sensitivity of 69.6% and specificity of 62.5%.
Figure 5
Figure 5
Kaplan-Meier curves of death rate stratified by multiples of the upper limit of normal for high sensitivity Troponin-T.
See this image and copyright information in PMC

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