Am J Cardiol . Impact and Determinants of High-Sensitivity Cardiac Troponin-T Concentration in Patients With COVID-19 Admitted to Critical Care

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Am J Cardiol


. 2021 Feb 19;S0002-9149(21)00148-X.
doi: 10.1016/j.amjcard.2021.01.037. Online ahead of print.
Impact and Determinants of High-Sensitivity Cardiac Troponin-T Concentration in Patients With COVID-19 Admitted to Critical Care


Ozan M Demir ¹ , Matthew Ryan ¹ , Chiara Cirillo ² , Nishita Desai ³ , Ana Pericao ³ , Hannah Sinclair ³ , Vasileios Stylianidis ³ , Kelly Victor ³ , Bashir Alaour ¹ , Andrew Jones ³ , Antonis N Pavlidis ³ , Andrew Retter ³ , Gerald Carr-White ⁴ , Luigi Camporota ³ , Nicholas Barrett ³ , Michael Marber ¹ , Divaka Perera ⁵



Affiliations

• PMID: 33617816
• DOI: 10.1016/j.amjcard.2021.01.037

Abstract

Cardiac Troponin (hs-TnT) elevation has been reported in unselected patients hospitalised with COVID-19 however the mechanism and relationship with mortality remain unclear. Consecutive patients admitted to a high-volume intensive care unit (ICU) in London with severe COVID-19 pneumonitis were included if hs-TnT concentration at admission was known. Kaplan-Meier survival analysis performed, with cohorts classified a priori by multiples of the upper limit of normal (ULN). 277 patients were admitted during a 7-week period in 2020; 176 were included (90% received invasive ventilation). hs-TnT at admission was 16.5 (9.0-49.3) ng/L, 56% had concentrations >ULN. 56 patients (31.8%) died during the index admission. Admission hs-TnT level was lower in survivors (12.0 (8.0-27.8) vs 28.5 (14.0-81.0) ng/L, p=0.001). Univariate predictors of mortality were age, APACHE-II Score and admission hs-TnT (HR 1.73, p=0.007). By multivariate regression, only age (HR 1.33, CI: 1.16.-1.51, p<0.01) and admission hs-TnT (HR 1.94, CI: 1.22-3.10, p=0.006) remained predictive. Survival was significantly lower when admission hs-TnT was >ULN (log-rank p-value<0.001). Peak hs-TnT was higher in those who died but was not predictive of death after adjustment for other factors. In conclusion, In critically ill patients with COVID-19 pneumonitis, the hs-TnT level at admission is a powerful independent predictor of the likelihood of surviving to discharge from ICU. In most cases, hs-TnT elevation does not represent major myocardial injury but acts as a sensitive integrated biomarker of global stress. Whether stratification based on admission Troponin level could be used to guide prognostication and management warrants further evaluation.

Keywords: biomarkers; coronavirus; intensive care unit; severe acute respiratory syndrome coronavirus 2.