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. 2021 Nov-Dec:55:107374.
doi: 10.1016/j.carpath.2021.107374. Epub 2021 Aug 3.

The prognostic value of cardiac troponin for 60 day mortality and major adverse events in COVID-19 patients

Max Ruge  1 , Joanne Michelle D Gomez  2 , Jeanne du Fay de Lavallaz  3 , Alexander Hlepas  3 , Annas Rahman  3 , Priya Patel  3 , Prutha Lavani  2 , Gatha G Nair  2 , Nusrat Jahan  2 , J Alan Simmons  4 , Anupama K Rao  2 , Kim A Williams Sr  2 , Annabelle Santos Volgman  2 , Karolina Marinescu  2 , Tisha Suboc  2
Affiliations

The prognostic value of cardiac troponin for 60 day mortality and major adverse events in COVID-19 patients

Max Ruge et al. Cardiovasc Pathol. 2021 Nov-Dec.

Abstract

Background: The variability of coronavirus disease 2019 (COVID-19) illness severity has puzzled clinicians and has sparked efforts to better predict who would benefit from rapid intervention. One promising biomarker for in-hospital morbidity and mortality is cardiac troponin (cTn).

Methods: A retrospective study of 1331 adult patients with COVID-19 admitted to the Rush University System in Illinois, USA was performed. Patients without cTn measurement during their admission or a history of end stage renal disease or stage 5 chronic kidney disease were excluded. Using logistic regression adjusted for baseline characteristics, pre-existing comorbidities, and other laboratory markers of inflammation, cTn was assessed as a predictor of 60-day mortality and severe COVID-19 infection, consisting of a composite of 60-day mortality, need for intensive care unit, or requiring non-invasive positive pressure ventilation or intubation.

Results: A total of 772 patients met inclusion criteria. Of these, 69 (8.9%) had mild cTn elevation (> 1 to < 2x upper limit of normal (ULN)) and 46 (6.0%) had severe cTn elevation (≥ 2x ULN). Regardless of baseline characteristics, comorbidities, and initial c-reactive protein, lactate dehydrogenase, and ferritin, when compared to the normal cTn group, mild cTn elevation and severe cTn elevation were predictors of severe COVID-19 infection (adjusted OR [aOR] aOR 3.00 [CI: 1.51 - 6.29], P < 0.01; aOR 9.96 [CI: 2.75 - 64.23], P < 0.01, respectively); severe cTn elevation was a predictor of in-hospital mortality (aOR 2.42 [CI: 1.10 - 5.21], P < 0.05) and 60-day mortality (aOR 2.45 [CI: 1.13 - 5.25], P < 0.05).

Conclusion: In our cohort, both mild and severe initial cTn elevation were predictors of severe COVID-19 infection, while only severe cTn elevation was predictive of 60-day mortality. First cTn value on hospitalization is a valuable longitudinal prognosticator for COVID-19 disease severity and mortality.

Keywords: Biomarker; COVID-19; Mortality; SARS-CoV-2; Troponin.

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Figures

Fig 1
Fig. 1
Inclusion criteria to define study population.
Fig 2
Fig. 2
Kaplan Meier Survival Estimates by First Cardiac Troponin Measurement A. Comparison of survival rates with adjusted odds ratios by presence or absence of cardiac troponin elevation. B. Comparison of survival rates with adjusted odds ratios by level of cardiac troponin elevation cTn = cardiac troponin; aOR = adjusted odds ratio *Defined as cardiac troponin > 1x upper limit of normal †Defined as cardiac troponin > 1 to < 2x upper limit of normal ‡Defined as cardiac troponin ≥ 2x upper limit of normal
See this image and copyright information in PMC

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