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Observational Study
. 2021 Jun;51(6):e13532.
doi: 10.1111/eci.13532. Epub 2021 Mar 15.

Cardiac troponin and COVID-19 severity: Results from BIOCOVID study

Luis García de Guadiana-Romualdo  1 , Daniel Morell-García  2 , Olaia Rodríguez-Fraga  3 , Cristian Morales-Indiano  4 , Ana María Lourdes Padilla Jiménez  5 , José Ignacio Gutiérrez Revilla  6 , Eloísa Urrechaga  7 , José María Álamo  8 , Ana María Hernando Holgado  9 , María Del Carmen Lorenzo-Lozano  10 , Silvia Sánchez Fdez-Pacheco  11 , Patricia de la Hera Cagigal  12 , María Ángeles Juncos Tobarra  13 , Juan A Vílchez  14 , Isabel Vírseda Chamorro 1st  15 , Irene Gutiérrez Garcia  16 , Yolanda Pastor Murcia  17 , Laura Sahuquillo Frías  18 , Laura Altimira Queral  19 , Elisa Nuez-Zaragoza  20 , Juan Adell Ruiz de León  21 , Alicia Ruiz Ripa  22 , Paloma Salas Gómez-Pablos  23 , Iria Cebreiros López  24 , Amaia Fernández Uriarte  25 , Álex Larruzea  26 , María Luisa López Yepes  27 , Natalia Sancho-Rodríguez  28 , María Consuelo Zamorano Andrés  29 , José Pedregosa Díaz  30 , Cristina Acevedo Alcaraz  31 , Alfonso-L Blázquez Manzanera  32 , Sonia Pérez Sanmartín  5 , María Del Carmen Baamonde Calzada  6 , Marina Vera  8 , Elena Valera Nuñez  10 , Magdalena Canalda Campás  11 , Sara García Muñoz  12 , Josep Miquel Bauça  2 , Luis Vicente Gutiérrez  13 , Laura Jiménez Añón  4 , Alfonso Pérez Martínez  14 , Aurelio Pons Castillo  15 , Ruth González Tamayo  16 , Jorge Férriz Vivancos  17 , María José Alcaide Martín  3 , Vicente Ferrer Díaz de Brito Fernández  33 , Vicente Aguadero  20 , María Gloria García Arévalo  21 , María Arnaldos Carrillo  24 , Mercedes González Morales  1 , María Núñez Gárate  25 , Cristina Ruiz Iruela  26 , Patricia Esteban Torrella  28 , Martí Vila Pérez  30 , Jose Manuel Egea-Caparrós  31 , Luis Sáenz  32 , Amparo Galán Ortega  34 , Luciano Consuegra-Sánchez  35
Affiliations
Observational Study

Cardiac troponin and COVID-19 severity: Results from BIOCOVID study

Luis García de Guadiana-Romualdo et al. Eur J Clin Invest. 2021 Jun.

Abstract

Background: Myocardial injury is a common finding in COVID-19 strongly associated with severity. We analysed the prevalence and prognostic utility of myocardial injury, characterized by elevated cardiac troponin, in a large population of COVID-19 patients, and further evaluated separately the role of troponin T and I.

Methods: This is a multicentre, retrospective observational study enrolling patients with laboratory-confirmed COVID-19 who were hospitalized in 32 Spanish hospitals. Elevated troponin levels were defined as values above the sex-specific 99th percentile upper reference limit, as recommended by international guidelines. Thirty-day mortality was defined as endpoint.

Results: A total of 1280 COVID-19 patients were included in this study, of whom 187 (14.6%) died during the hospitalization. Using a nonspecific sex cut-off, elevated troponin levels were found in 344 patients (26.9%), increasing to 384 (30.0%) when a sex-specific cut-off was used. This prevalence was significantly higher (42.9% vs 21.9%; P < .001) in patients in whom troponin T was measured in comparison with troponin I. Sex-specific elevated troponin levels were significantly associated with 30-day mortality, with adjusted odds ratios (ORs) of 3.00 for total population, 3.20 for cardiac troponin T and 3.69 for cardiac troponin I.

Conclusion: In this multicentre study, myocardial injury was a common finding in COVID-19 patients. Its prevalence increased when a sex-specific cut-off and cardiac troponin T were used. Elevated troponin was an independent predictor of 30-day mortality, irrespective of cardiac troponin assay and cut-offs to detect myocardial injury. Hence, the early measurement of cardiac troponin may be useful for risk stratification in COVID-19.

Keywords: COVID-19; SARS-CoV-2; cardiac troponin I; cardiac troponin T; myocardial injury; prognosis.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Figures

FIGURE 1
FIGURE 1
Flow chart of patient recruitment
FIGURE 2
FIGURE 2
Cumulative incidence of 30‐day mortality during hospitalization stratified by baseline cardiac troponin level
FIGURE 3
FIGURE 3
Cumulative incidence of 30‐day mortality during hospitalization stratified by baseline cardiac troponin T level
FIGURE 4
FIGURE 4
Cumulative incidence of 30‐day mortality during hospitalization stratified by baseline cardiac troponin I level
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