The impact of daily troponin-I and D-dimer serum levels on mortality of moderate-to-severe COVID-19 pneumonia patients

ABSTRACT

Introduction: Coronavirus Disease 2019 (COVID-19) caused by that infection resulted in a very high morbidity and mortality rates globally. Purpose: The aim of this study is to analyses the daily Troponin-I and Ddimer levels and their impact on the need for intensive care and mortality of the COVID-19 infected patients. Methods: 206 patients who were hospitalized between 20.03.2020- 05.05.2020 with a diagnosis of moderate-to-severe COVID-19 pneumonia were analyzed retrospectively. Serum Troponin-I and D-dimer levels were recorded at least 10 days. Results: Average age was higher in mortality group compared to nonmortality group (respectively 67.79±14.9, 56.87±18.15, p<0.001). Presence of hypertension, diabetes mellitus, previous coronary bypass surgery, heart failure, chronic renal failure and chronic obstructive pulmonary disease were statistically significant affecting mortality (respectively p0.003, p0.004, p0.045, p0.02, p0.003, p0.007). First 10 days measurements of Troponin-I and D-dimer values was associated with mortality and intensive care requirement (p<0.001). Both Troponin-I and D-dimer were higher in mortality group compared to the patients requiring intensive care. Troponin- I value on the 7th day ≥16.05 pg/ml was related with need for intensive care (AUC 0.896, sensitivity %78.6, specificity %78.3, p<0.001). Troponin-I value ≥30.25 pg/ml on the 9th day was related with mortality (AUC 0.920, sensitivity %89.5, specificity %89.3, p<0.001). D-dimer value ≥878 hg/ml on the 2nd day was associated with intensive care need (AUC 0.896, sensitivity %78.6, specificity %78.3, p<0.001). D-dimer value ≥1106 hg/ml on the 10th day was associated with mortality (AUC 0.817, sensitivity %68.4, specificity %65.2, p<0.001). It was observed that hospitalization periods ≥9.5 days were associated with mortality (AUC 0.738, sensitivity %68.4, specificity %65.9, p<0.001). Conclusion: We observed that hospitalizations ≥9.5 days increased mortality. Troponin-I and D-dimer follow-ups in serum are more effective than other inflammatory markers to show the need for intensive care and mortality. A high Troponin-I value should alert the clinician in terms of clinical deterioration.