Cardiac Troponin I association with critical illness and death risk in 726 seriously ill COVID-19 patients: A retrospective cohort study

Abstract

Background: For coronavirus disease 2019 (COVID-19), early identification of patients with serious symptoms at risk of critical illness and death is important for personalized treatment and balancing medical resources. Methods: Demographics, clinical characteristics, and laboratory tests data from 726 patients with serious COVID-19 at Tongji Hospital (Wuhan, China) were analyzed. Patients were classified into critical group (n = 174) and severe group (n= 552), the critical group was sub-divided into survivors (n = 47) and non-survivors (n = 127). Results: Multivariable analyses revealed the risk factors associated with critical illness in serious patients were: Advanced age, high respiratory rate (RR), high lactate dehydrogenase (LDH) level, high hypersensitive cardiac troponin I (hs-cTnI) level, and thrombocytopenia on admission. High hs-cTnI level was the independent risk factor of mortality among critically ill patients in the unadjusted and adjusted models. ROC curves demonstrated that hs-cTnI and LDH were predictive factors for critical illness in patients with serious COVID-19 whereas procalcitonin and D-Dimer with hs-cTnI and LDH were predictive parameters in mortality risk. Conclusions: Advanced age, high RR, LDH, hs-cTnI, and thrombocytopenia, constitute risk factors for critical illness among patients with serious COVID-19, and the hs-cTnI level helps predict fatal outcomes in critically ill patients.

Keywords: Coronavirus disease 2019 (COVID-19); hypersensitive cardiac troponin I (hs-cTnI); lactate dehydrogenase (LDH); prognosis; severe acute respiratory syndrome coronavirus (SARS-CoV-2).

Figure 1

A flow diagram for COVID-19 patient recruitment in this study. *Key clinical data mainly refer to the time from illness onset to hospital admission, treatment options, and comorbidity details. COVID-19, Coronavirus disease 2019.

Figure 2

The diagnostic value of some clinical chemistry parameters for predicting critical outcomes or fatal outcomes from serious COVID-19 were analyzed using ROC curves (only parameters with an AUC higher than 70% are listed). A-B) The ROC curve of hs-cTnI and LDH for predicting critical illness from serious cases respectively. C-F The ROC curve for predicting fatal outcomes from serious COVID-19 (severe and critical cases). ROC, Receiver operating characteristic; AUC, Area under the curve; hs-cTnI, Hypersensitive cardiac troponin I; LDH, Lactate dehydrogenase; PCT, Procalcitonin.

Figure 3

Comparison of the main therapeutic methods (A) and comorbidities (B) between serious COVID-19 patients with initial hs-cTnI concentrations on admission > 28 pg/mL and ≤ 28 pg/mL. Four patients suffered from cardiac diseases that were not termed as coronary heart disease. Two patients had bradycardia after cardiac pacemaker surgery (1 patient with hs-cTnI > 28 pg/mL and another with hs-cTnI ≤ 28 pg/mL), one patient had heart failure (hs-cTnI > 28 pg/mL) and one patient suffered from heart valve insufficiency (hs-cTnI > 28 pg/mL). COVID-19, Coronavirus disease 2019; IVIG, Intravenous immunoglobin; NIV, Non-invasive mechanical ventilation; IV, Invasive mechanical ventilation; hs-cTnI, Hypersensitive cardiac troponin I.