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Multicenter Study
. 2021 Oct;8(5):3504-3511.
doi: 10.1002/ehf2.13462. Epub 2021 Jul 8.

The prognostic value of serial troponin measurements in patients admitted for COVID-19

Vincenzo Nuzzi  1 , Marco Merlo  1 , Claudia Specchia  2 , Carlo Mario Lombardi  3 , Valentina Carubelli  3 , Annamaria Iorio  4 , Riccardo Maria Inciardi  3 , Antonio Bellasi  5 , Claudia Canale  6 , Rita Camporotondo  7 , Francesco Catagnano  8 , Laura Adelaide Dalla Vecchia  9 , Stefano Giovinazzo  6 , Gloria Maccagni  3   10 , Massimo Mapelli  11   12 , Davide Margonato  8 , Luca Monzo  13   14 , Chiara Oriecuia  2   3 , Giulia Peveri  2   12 , Andrea Pozzi  4 , Giovanni Provenzale  15 , Filippo Sarullo  16 , Daniela Tomasoni  3 , Pietro Ameri  6 , Massimiliano Gnecchi  7   17 , Sergio Leonardi  7   17 , Piergiuseppe Agostoni  11   12 , Stefano Carugo  15 , Gian Battista Danzi  10 , Marco Guazzi  18   19 , Maria Teresa La Rovere  20 , Andrea Mortara  8 , Massimo Piepoli  21   22 , Italo Porto  6 , Maurizio Volterrani  23 , Michele Senni  4 , Marco Metra  3 , Gianfranco Sinagra  1
Affiliations
Multicenter Study

The prognostic value of serial troponin measurements in patients admitted for COVID-19

Vincenzo Nuzzi et al. ESC Heart Fail. 2021 Oct.

Abstract

Aims: Myocardial injury (MI) in coronavirus disease-19 (COVID-19) is quite prevalent at admission and affects prognosis. Little is known about troponin trajectories and their prognostic role. We aimed to describe the early in-hospital evolution of MI and its prognostic impact.

Methods and results: We performed an analysis from an Italian multicentre study enrolling COVID-19 patients, hospitalized from 1 March to 9 April 2020. MI was defined as increased troponin level. The first troponin was tested within 24 h from admission, the second one between 24 and 48 h. Elevated troponin was defined as values above the 99th percentile of normal values. Patients were divided in four groups: normal, normal then elevated, elevated then normal, and elevated. The outcome was in-hospital death. The study population included 197 patients; 41% had normal troponin at both evaluations, 44% had elevated troponin at both assessments, 8% had normal then elevated troponin, and 7% had elevated then normal troponin. During hospitalization, 49 (25%) patients died. Patients with incident MI, with persistent MI, and with MI only at admission had a higher risk of death compared with those with normal troponin at both evaluations (P < 0.001). At multivariable analysis, patients with normal troponin at admission and MI injury on Day 2 had the highest mortality risk (hazard ratio 3.78, 95% confidence interval 1.10-13.09, P = 0.035).

Conclusions: In patients admitted for COVID-19, re-test MI on Day 2 provides a prognostic value. A non-negligible proportion of patients with incident MI on Day 2 is identified at high risk of death only by the second measurement.

Keywords: COVID-19; COVID-19 outcome; Myocardial injury; Troponin trajectories.

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Conflict of interest statement

Dr Carubelli received consulting honoraria from CVie Therapeutics Limited, Servier, and Windtree Therapeutics outside the submitted work. Dr Ameri reported having received speaker and advisor honoraria from Novartis, AstraZeneca, Vifor, Daiichi Sankyo, Boehringer Ingelheim, Pfizer, GlaxoSmithKline, and Merck, Sharp & Dohme and nonfinancial support from Actelion outside the submitted work. Dr Leonardi reported grants and personal fees from AstraZeneca and personal fees from BMS/Pfizer, Novo Nordisk, and Chiesi outside the submitted work. Dr Agostoni reported nonfinancial support from Menarini, Novartis, and Boehringer; grants from Daiichiò Sankyo and Bayer; and grants and nonfinancial support from Actelion outside the submitted work. Dr Mortara reports personal consulting honoraria from Novartis, Servier, Astra Zeneca for participation to advisory board meetings and receives grants from Novartis and Niccomo for research trials. Dr Piepoli reported having received research grants and speaking fees from Novartis, Servier, and TRX and nonfinancial support from Vifor outside the submitted work. Dr Metra reported personal consulting honoraria from Abbott Vascular, Amgen, Bayer, Edwards Therapeutics, Servier, Vifor Pharma, and Windtree Therapeutics for participation to advisory board meetings and executive committees of clinical trials. Dr Senni reported personal fees from Novartis, Abbott, Merck, Bayer, Boehringer, Vifor, and AstraZeneca outside the submitted work.

Figures

Figure 1
Figure 1
Intra‐hospital mortality stratifying patients according to the trend of troponin level during the first two days of hospitalization [normal troponin (N = 81) vs. normal troponin then elevated (N = 15) vs. elevated troponin then normal (N = 14) vs. elevated troponin (N = 87), overall P value: 0.001].
Figure 2
Figure 2
Cumulative incidence function for intra‐hospital mortality stratifying patients according to the trend of troponin level during the first 2 days of hospitalization: normal troponin vs. normal troponin then elevated vs. elevated troponin then normal vs. elevated troponin.
See this image and copyright information in PMC

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