Initial High Sensitivity Troponin I Values Predict 28 Day Survival in Coronavirus-19 Patients

Objectives: To determine the 28 day survival prognostic value of the initial Emergency Department (ED) high sensitivity cardiac troponin I (hs-cTnI) measurement in coronavirus-19 disease 2019 (COVID-19) patients. Background(s): Recent reports indicate that the presence of cardiac injury [troponin level > the 99th percentile upper reference limit (99th % URL) using mostly contemporary assays] is predictive of death within 30 days during hospitalization of COVID-19 patients. Troponin values ordered in the ED or after hospitalization were used for these analyses. Method(s): Using an ED centric electronic database of COVID-19 patients (nasopharyngeal swab testing within 1 week prior to or during the ED visit) having at least 1 hs-cTnI (Beckman Coulter, Brea, CA;level of quantitation (LoQ) 4ng/L, non sex specific 99th percentile URL 18 ng/L) value reported during a visit to an urban, academic ED in the United States. All patients were followed for 28 days to determine all-cause mortality. Kaplan Meir survival curves were constructed to compare outcomes amongst predetermined initial hs-cTnI value intervals. Result(s): From March 16-November 2, 2020 1476 consecutive ED COVID-19 patients were identified with 1044 (70.7%) having at least 1 hs-cTnI value resulted in the ED. Patients' mean age and body mass index were 60.8 +/- 16.1 years and 32.4 +/- 11.3 kg/m2 respectively. 531 (50.9%) were male, 804 (77.0%) self-identified as African American and 615 (58.9%) had 2 or more comorbidities with hypertension (42.5%), diabetes (37.4%) and hyperlipidemia (27.23%) commonest. Hs-cTnI interval values were: 147 (14.1%) < 4 (LoQ), 359 (34.4%) 4-10 and 151 (14.5%) 11-18 ng/L. Hs-cTnI values were > 99th % URL in 387 (37.1%) patients with 230 (22.0%) 19-54, 63 (6.0%) 54-99 and 94 (9.0%) = 100 (laboratory reported critical value) ng/L. 145 (13.9%) patients were discharged directly home and 2 (0.2%) died in the ED. 147 (14.1%) were admitted to an ICU with 104 (70.7%) dying. Each of the interval initial ED hs-cTnI values was associated with a different (p < 0.001) 28 day survival curve (Figure). Conclusion(s): Most COVID-19 patients had a hs-cTnI value obtained with 85.9% of these > 4 ng/L. No one with an initial hs-cTnI < 4 ng/L died within 28 days while increasing presenting hs-cTnI values > 4 ng/L were associated with decreased 28 day survival. Our findings indicate that in COVID-19 patients detectable initial ED hs-cTnI values, whether reaching thresholds for cardiac injury or not, are highly prognostic of 28 day survival.Copyright © 2023

High sensitivity troponin I and newly/recently diagnosed coronavirus-19 disease patients presenting to the emergency department: Values above and below the 99th percentile predict 28 day mortality

Background: Studies indicate that the presence of cardiac injury [troponin level > the 99th percentile upper reference limit (99th % URL) using mostly contemporary assays] is predictive of death within 30 days during hospitalization of coronavirus disease 2019 (COVID-19) patients. Troponin measurements in these reports were ordered and/or resulted in the Emergency Department (ED) or during various times after hospital admission and not all patients were followed for 30 days. Purpose(s): Our objective was to determine the 28 day survival prognostic value of Emergency Department (ED) resulted high sensitivity cardiac troponin I (hs-cTnI) measurements in all COVID-19 patients including those discharged after their ED visit or hospitalization. Method(s): An ED centric electronic database of COVID-19 patients (nasopharyngeal swab testing within 1 week prior to or during the ED visit) having at least 1 hs-cTnI (Beckman Coulter, Brea, CA;level of quantitation (LoQ) 4ng/L, non sex specific 99th % URL 18 ng/L) value reported during a visit to an urban, academic ED in the United States was constructed. All patients were followed for 28 days and Kaplan Meir survival curves constructed amongst predetermined initial hs-cTnI value intervals. Result(s): From March 16-November 2, 2020 1476 consecutive ED COVID- 19 patients were identified with 1044 (70.7%) having at least 1 hs-cTnI value resulted in the ED. Patients' mean age and body mass index were 60.8+/-16.1 years and 32.4+/-11.3 kg/m2 respectively. 531 (50.9%) were male, 804 (77.0%) self-identified as African American and 615 (58.9%) had 2 or more comorbidities with hypertension (42.5%), diabetes (37.4%) and hyperlipidemia (27.23%) commonest. Frequent primary presenting complaints were shortness of breath (37.7%), fever/chills (14.5%) and cough (11.9%). Hs-cTnI interval values were: 147 (14.1%) <4 (LoQ), 359 (34.4%) 4-10 and 151 (14.5%) 11-18 ng/L. Hs-cTnI values were >99th % URL in 387 (37.1%) patients with 230 (22.0%) 19-54, 63 (6.0%) 54-99 and 94 (9.0%) >=100 (laboratory reported critical value) ng/L. 145 (13.9%) patients were discharged directly home and 2 (0.2%) died in the ED. 147 (14.1%) were admitted to an ICU with 104 (70.7%) dying. Each of the interval initial ED hs-cTnI values was associated with a different (p<0.001) 28 day survival curve. Conclusion(s): Most COVID-19 patients had a hs-cTnI value obtained with 85.9% of these >4 ng/L. No one with an initial hs-cTnI <4 ng/L died within 28 days while increasing presenting hs-cTnI values >4 ng/L were associated with decreased 28 day survival. Our findings indicate that in COVID-19 patients detectable initial ED hs-cTnI values, whether reaching thresholds for cardiac injury or not, are highly prognostic of 28 day survival. Studies are needed to better define how hs-cTnI values could alter early management of COVID-19 disease to improve outcomes for these patients. (Figure Presented).

All Initial High Sensitivity Cardiac Troponin I Values Are Prognostic for 28 Day Survival in Coronavirus-19 Disease Patients

Study Objectives: Recent reports indicate that the presence of cardiac injury [troponin level > the 99th percentile upper reference limit (99th % URL) using mostly contemporary assays] is predictive of death within 30 days during hospitalization of coronavirus disease 2019 (COVID-19) patients. Troponin values ordered in the emergency department (ED) or after hospitalization were used for these analyses. Our objective was to determine the 28 day survival prognostic value of ED resulted high sensitivity cardiac troponin I (hs-cTnI) measurements in COVID-19 patients. Methods: We established an ED centric electronic database of COVID-19 patients (nasopharyngeal swab testing within 1 week prior to or during the ED visit) having at least 1 hs-cTnI (Beckman Coulter, Brea, CA;level of quantitation (LoQ) 4ng/L, non sex specific 99th percentile URL 18 ng/L) value reported during a visit to an urban, academic ED in the United States. All patients, whether admitted and expired in the hospital or hospital discharged or sent home directly from the ED were followed for 28 days to determine all-cause mortality. Kaplan Meir survival curves were constructed to compare outcomes amongst predetermined initial hs- cTnI value intervals. Results: From March 16-November 2, 2020 1476 consecutive ED COVID-19 patients were identified with 1044 (70.7%) having at least 1 hs-cTnI value resulted in the ED. Patients’ mean age and body mass index were 60.8 ± 16.1 years and 32.4 ± 11.3 kg/m2 respectively. 531 (50.9%) were male, 804 (77.0%) self-identified as African American and 615 (58.9%) had 2 or more comorbidities with hypertension (42.5%), diabetes (37.4%) and hyperlipidemia (27.23%) commonest. Frequent primary presenting complaints were shortness of breath (37.7%), fever/chills (14.5%) and cough (11.9%). Hs-cTnI interval values were: 147 (14.1%) < 4 (LoQ), 359 (34.4%) 4-10 and 151 (14.5%) 11-18 ng/L. Hs-cTnI values were > 99th % URL in 387 (37.1%) patients with 230 (22.0%) 19-54, 63 (6.0%) 54-99 and 94 (9.0%) ≥ 100 (laboratory reported critical value) ng/L. 145 (13.9%) patients were discharged directly home and 2 (0.2%) died in the ED. 147 (14.1%) were admitted to an ICU with 104 (70.7%) dying. Each of the interval initial ED hs-cTnI values was associated with a different (p < 0.001) 28 day survival curve (Figure). Conclusions: Most COVID-19 patients had a hs-cTnI value obtained with 85.9% of these > 4 ng/L. No one with an initial hs-cTnI < 4 ng/L died within 28 days while increasing presenting hs-cTnI values > 4 ng/L were associated with decreased 28 day survival. Our findings indicate that in COVID-19 patients detectable initial ED hs-cTnI values, whether reaching thresholds for cardiac injury or not, are highly prognostic of 28 day survival. Studies are needed to better define how hs-cTnI values could alter early management of COVID-19 disease to improve outcomes for these patients. [Formula presented]