Predictive value of troponin, ntprobnp and sodium on adverse clinical outcomes in COVID-19

ABSTRACT

Background: Cardiac injury has been identified as an independent risk factor of mortality in COVID-19, but early recognition of severe COVID-19 illness remains challenging. Several lab parameters have been proposed to help guide clinical decisions. This study aimed to evaluate the association between troponin (TN), N-terminal pro-brain naturietic peptide (BNP), and sodium and adverse clinical outcomes in COVID-19.Methods: This retrospective single-center cohort included consecutive COVID-19 patients admitted to the George Washington University Hospital between March 2020 and May 2020. Patient demographics, cardiovascular comorbidities, and laboratory values were examined. Elevated TN and BNP were defined as >0.02 ng/mL and >150 ng/L, respectively. Primary outcomes included ICU admission and mortality. The presence of underlying cardiovascular disease (CVD) was analyzed to evaluate for relative effect on clinical outcomes. Chi-square and multinomial regression models were utilized to evaluate the association between biomarkers and clinical outcomes.Results: 290 patients were identified with a median age of 62 and the majority were male (52.4%), Black (71.3%), and had CVD risk factors (72.1%). ICU admission occurred in 88 (30.3%) while death occurred in 74 (25.5%) individuals. Patients with both an elevated TN and CVD were more likely to experience ICU admission or death (OR=2.55, p=0.017) while patients with both elevated TN and elevated BNP had markedly increased odds of ICU admission or death (OR=7.53, p<0.001). Among patients with CVD, hypernatremia (Na>145) was associated with over an eight-fold increased odds of ICU admission or death (OR=8.57, p<0.001). An isolated elevated BNP with CVD did not increase the risk of primary events.Conclusion: Among COVID-19 patients with underlying CVD, the presence of an elevated TN or hypernatremia was associated with significantly increased odds of ICU admission or death. Elevated BNP with CVD did not increase risk of events. Identifying these factors on presentation may prove helpful for early triage of high-risk patients.