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Multicenter Study
. 2021 Mar 5;10(1):6-15.
doi: 10.1093/ehjacc/zuaa019.

The peak levels of highly sensitive troponin I predicts in-hospital mortality in COVID-19 patients with cardiac injury: a retrospective study

Yaxin Wang  1 , Huaqing Shu  1 , Hong Liu  1 , Xia Li  2 , Xing Zhou  2 , Xiaojing Zou  1 , Shangwen Pan  1 , Jiqian Xu  1 , Dan Xu  1 , Xin Zhao  1 , Xiaobo Yang  1 , Yuan Yu  1 , Yin Yuan  1 , Hong Qi  1 , Qiongya Wang  2 , You Shang  1
Affiliations
Multicenter Study

The peak levels of highly sensitive troponin I predicts in-hospital mortality in COVID-19 patients with cardiac injury: a retrospective study

Yaxin Wang et al. Eur Heart J Acute Cardiovasc Care. .

Abstract

Aims: To investigate the association between levels of highly sensitive troponin I (hs-troponin I) and mortality in novel coronavirus disease 2019 (COVID-19) patients with cardiac injury.

Methods and results: We retrospectively reviewed the medical records of all COVID-19 patients with increased levels of hs-troponin I from two hospitals in Wuhan, China. Demographic information, laboratory test results, cardiac ultrasonographic findings, and electrocardiograms were collected, and their predictive value on in-hospital mortality was explored using multivariable logistic regression. Of 1500 patients screened, 242 COVID-19 patients were enrolled in our study. Their median age was 68 years, and (48.8%) had underlying cardiovascular diseases. One hundred and seventy-six (72.7%) patients died during hospitalization. Multivariable logistic regression showed that C-reactive protein (>75.5 mg/L), D-dimer (>1.5 μg/mL), and acute respiratory distress syndrome were risk factors of mortality, and the peak hs-troponin I levels (>259.4 pg/mL) instead of the hs-troponin I levels at admission was predictor of death. The area under the receiver operating characteristic curve of the peak levels of hs-troponin I for predicting in-hospital mortality was 0.79 (95% confidence interval, 0.73-0.86; sensitivity, 0.80; specificity, 0.72; P < 0.0001).

Conclusion: Our results demonstrated that the risk of in-hospital death among COVID-19 patients with cardiac injury can be predicted by the peak levels of hs-troponin I during hospitalization and was significantly associated with oxygen supply-demand mismatch, inflammation, and coagulation.

Keywords: COVID-19; Cardiac injury; Levels of troponin I at admission; Mortality; Peak levels of troponin I.

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Figures

Figure 1
Figure 1
Kaplan–Meier analysis of survival rates in COVID-19 patients with cardiac injury. (A) The overall survival rate in COVID-19 patients with cardiac injury. (B) The survival rate in patients with hs-troponin I >28 pg/mL and hs-TNI ≤28 pg/mL at admission. (C) Survival rate in patients with peak hs-TNI >259.4 pg/mL and the peak hs-troponin I≤259.4 pg/mL, P < 0.0001 by log-rank test. (D) Survival rate in patients with the hs-troponin I level >259.4 pg/mL and the hs-troponin I level ≤259.4 pg/mL at admission, P < 0.0001 by log-rank test. hs-TNI, highly sensitive troponin I.
Figure 2
Figure 2
Multivariable Cox regression analysis of clinical indicators of in-hospital mortality in COVID-19 patients with cardiac injury. The peak hs-troponin I level >259.4 pg/mL and ARDS were risk factors. The peak hs-troponin I levels were transformed into categorical variables according to cut-off point (259.4 pg/mL). ARDS, acute respiratory distress syndrome; hs-troponin I, highly sensitive troponin I.
Figure 3
Figure 3
Receiver operating characteristic analysis of the clinical prediction mode. Prediction of in-hospital mortality by the peak hs-troponin I levels during hospitalization and the initial hs-troponin I levels at admission. hs-troponin I, highly sensitive troponin I.
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