TROPONIN-I PREDICTS MAJOR ADVERSE CARDIOVASCULAR EVENTS AND RISK OF MORTALITY IN COVID-19 PATIENTS

Background

Cardiac biomarkers such as troponin-I (TnI) are useful in assessing for cardiovascular events. COVID-19 patients can experience cardiovascular complications. We examined whether elevated TnI levels are predictive of a major adverse cardiovascular event (MACE) and mortality in COVID-19 patients.

Methods

A retrospective review was performed on 496 hospitalized COVID-19 patients between March and May 2020 in four hospitals in one health system, including a major metropolitan quaternary care hospital in Southwest United States. Baseline characteristics and clinical outcomes of their disease course were identified. We documented the admission and peak TnI levels, and noted the occurrence of a MACE (a composite of myocardial infarction [MI], stroke, pulmonary embolism [PE], deep venous thrombosis [DVT], or shock requiring vasopressor support) or death. Survival analysis was performed on patients that experienced a MACE and those that did not. Pearson's chi square test was used to examine the difference in mortality between the groups.

Results

Of the 496 patients, 122 had a MACE and 374 did not. Specifically, 30 (6.05%) patients experienced a type 1 or type 2 MI, 5 (1.01%) experienced stroke, 19 (3.83%) experienced PE/DVT, and 90 (18.15%) experienced shock. Out of 351 patients that had TnI measured during their hospital course, 147 (41.88%) had elevated TnI levels and among those, 67 (45.58%) had a MACE. Out of 204 patients (58.88%) that had normal TnI levels, only 35 (17%) had a MACE. Patients with a MACE were significantly more likely to die than those without a MACE (p-value <0.0001; OR = 16.06; 95% CI ([8.26, 32.33]). Patients with MACE/mortality were more than four times more likely to have had an elevated TnI level during their disease course than patients who did not experience MACE/mortality (p = <0.0001; OR = 4.55; 95% CI [2.75, 7.57]).

Conclusion

Elevated TnI levels predict the occurrence of a MACE in hospitalized COVID-19 patients. Furthermore, there is an association between elevated TnI and an eventual MACE and/or mortality. It is important for clinicians to remain vigilant in assessing for the occurrence of these events, and one method of doing so would be by checking TnI levels.