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. 2021 Apr 13;10(8):1656.
doi: 10.3390/jcm10081656.

Admission High-Sensitive Cardiac Troponin T Level Increase Is Independently Associated with Higher Mortality in Critically Ill Patients with COVID-19: A Multicenter Study

Romaric Larcher  1   2 , Noemie Besnard  3 , Aziz Akouz  4 , Emmanuelle Rabier  5 , Lauranne Teule  4 , Thomas Vandercamere  5 , Samuel Zozor  1 , Matthieu Amalric  3 , Racim Benomar  3 , Vincent Brunot  3 , Philippe Corne  3 , Olivier Barbot  4 , Anne-Marie Dupuy  1 , Jean-Paul Cristol  1   2 , Kada Klouche  2   3
Affiliations

Admission High-Sensitive Cardiac Troponin T Level Increase Is Independently Associated with Higher Mortality in Critically Ill Patients with COVID-19: A Multicenter Study

Romaric Larcher et al. J Clin Med. .

Abstract

Background: In coronavirus disease 2019 (COVID-19) patients, increases in high-sensitive cardiac troponin T (hs-cTnT) have been reported to be associated with worse outcomes. In the critically ill, the prognostic value of hs-cTnT, however, remains to be assessed given that most previous studies have involved a case mix of non- and severely ill COVID-19 patients.

Methods: We conducted, from March to May 2020, in three French intensive care units (ICUs), a multicenter retrospective cohort study to assess in-hospital mortality predictability of hs-cTnT levels in COVID-19 patients.

Results: 111 laboratory-confirmed COVID-19 patients (68% of male, median age 67 (58-75) years old) were included. At ICU admission, the median Charlson Index, Simplified Acute Physiology Score II, and PaO2/FiO2 were at 3 (2-5), 37 (27-48), and 140 (98-154), respectively, and the median hs-cTnT serum levels were at 16.0 (10.1-31.9) ng/L. Seventy-five patients (68%) were mechanically ventilated, 41 (37%) were treated with norepinephrine, and 17 (15%) underwent renal replacement therapy. In-hospital mortality was 29% (32/111) and was independently associated with lower PaO2/FiO2 and higher hs-cTnT serum levels.

Conclusions: At ICU admission, besides PaO2/FiO2, hs-cTnT levels may allow early risk stratification and triage in critically ill COVID-19 patients.

Keywords: COVID-19; ICU; SARS-CoV-2; high-sensitive cardiac troponin T; myocardial injury; outcomes.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the study population. ICU, intensive care unit; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
Figure 2
Figure 2
Receiver operating characteristic (ROC) curves of age (purple semi-dashed line), initial PaO2/FiO2 ratio (blue dashed line), initial high-sensitive cardiac troponin T (hs-cTnT, red line), initial D-Dimer (green dotted line), and initial C reactive protein (CRP, orange dashed and dotted line) for predicting in-hospital mortality in critically ill patients with COVID-19.
Figure 3
Figure 3
Kaplan–Meier curve of 90-day survival after ICU admission of critically ill patients with COVID-19: (A) hs-cTnT < 22 ng/L versus hs-cTnT > 22 ng/L; (B) no acute respiratory distress syndrome (ARDS) (PaO2/FiO2 >300) versus mild (PaO2/FiO2 = 201–300), moderate (PaO2/FiO2 = 101–200), and severe ARDS (PaO2/FiO2 ≤ 100).
Figure 3
Figure 3
Kaplan–Meier curve of 90-day survival after ICU admission of critically ill patients with COVID-19: (A) hs-cTnT < 22 ng/L versus hs-cTnT > 22 ng/L; (B) no acute respiratory distress syndrome (ARDS) (PaO2/FiO2 >300) versus mild (PaO2/FiO2 = 201–300), moderate (PaO2/FiO2 = 101–200), and severe ARDS (PaO2/FiO2 ≤ 100).
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