Troponin T in COVID-19 hospitalized patients: Kinetics matter

Abstract

Background: Coronavirus disease 2019 (COVID-19) emerged as a worldwide health crisis, overwhelming healthcare systems. Elevated cardiac troponin T (cTn T) at admission was associated with increased in-hospital mortality. However, data addressing the role of cTn T in major adverse cardiovascular events (MACE) in COVID-19 are scarce. Therefore, we assessed the role of baseline cTn T and cTn T kinetics for MACE and in-hospital mortality prediction in COVID-19.

Methods: Three hundred and ten patients were included prospectively. One hundred and eight patients were excluded due to incomplete records. Patients were divided into three groups according to cTn T kinetics: ascending, descending, and constant. The cTn T slope was defined as the ratio of the cTn T change over time. The primary and secondary endpoints were MACE and in-hospital mortality.

Results: Two hundred and two patients were included in the analysis (mean age 64.4 ± 16.7 years, 119 [58.9%] males). Mean duration of hospitalization was 14.0 ± 12.3 days. Sixty (29.7%) patients had MACE, and 40 (19.8%) patients died. Baseline cTn T predicted both endpoints (p = 0.047, hazard ratio [HR] 1.805, 95% confidence interval [CI] 1.009-3.231; p = 0.009, HR 2.322, 95% CI 1.234-4.369). Increased cTn T slope predicted mortality (p = 0.041, HR 1.006, 95% CI 1.000-1.011). Constant cTn T was associated with lower MACE and mortality (p = 0.000, HR 3.080, 95% CI 1.914-4.954, p = 0.000, HR 2.851, 95% CI 1.828-4.447).

Conclusions: The present study emphasizes the additional role of cTn T testing in COVID-19 patients for risk stratification and improved diagnostic pathway and management.

Keywords: COVID-19; cardiac troponin; kinetics; major cardiovascular adverse events; mortality; myocardial injury.

Figure 1

Receiver operating characteristics (ROC) and Kaplan-Meier analysis illustrating the role of baseline cardiac troponin T (cTn T) in major adverse cardiovascular events (MACE) and in-hospital mortality in COVID-19 patients. ROC analysis for baseline cTn T for predicting MACE (A) and in-hospital mortality (C). Kaplan-Meier survival curve analysis for MACE, Log Rank (Matel-Cox) value = 0.000 (B) and in-hospital mortality, Log Rank (Matel-Cox) value = 0.000 (D).

Figure 2

Kaplan-Meier survival analysis on the role of constant troponin profile in major adverse cardiovascular events (MACE) and in-hospital mortality in COVID-19 patients. Kaplan-Meier survival curve analysis for MACE, Log Rank (Matel-Cox) value = 0.000 (A) and in-hospital mortality, Log Rank (Matel-Cox) value = 0.000 (B).

Figure 3

Alluvial plot illustrating the distribution of values of baseline cardiac troponin T (cTn T) in COVID-19 patients divided into three kinetics profiles according on the values during hospitalization of cardiac troponin (ascending cTn T, descending cTn T, and constant cTn T) and the association with major cardiovascular events. First column: patients were divided into two groups based on the best cut-off value of baseline cTn T of 0.014 μg/mL (green: cTn T< 0.014 μg/mL, purple: cTn T ≥ 0.014 μg/mL), which was shown as an independent predictor for major adverse cardiovascular events (MACE). Second column: patients were separated into three cTn T kinetics profiles: ascending troponin profile (orange), descending troponin profile (yellow), constant troponin profile (pink). Third column: Patients without MACE. Patients with MACE.