Role of troponin levels, grace score, and timi score in predicting mortality in covid-19 related myocardial injury

ABSTRACT

Introduction: COVID-19 infection is associated with troponin elevation, which is associated with increased mortality. We wanted to evaluate whether troponin levels, GRACE scores, and TIMI scores were independently associated with mortality in COVID-19 patients. Methods: Out of 1500 COVID-19 patients admitted to our hospitals, 217 patients with troponin levels were included. Key variables were collected manually, and survival analysis was done. Results: Mortality was 26.5% in the normal troponin group and 54.6% in the elevated troponin group. Patients with elevated troponins had increased frequency of hypotension (P=0.01), oxygen support (P<0.01), low absolute lymphocyte count (P<0.01), elevated blood urea nitrogen (P<0.01), higher C-reactive protein (P<0.01), higher D-dimer (P<0.01), higher lactic acid (P<0.01), and higher qSOFA, SOFA, TIMI, and GRACE scores (all scores P<0.01). On cox regression, troponin elevation (HR 1.85, 95% CI 1.18-2.88, P<0.01), TIMI score >3 (HR 1.79, 95% CI 1.11-2.75, P=0.01), GRACE score >140 (HR 2.27, 95% CI 1.45-3.55, P<0.01) were highly associated with mortality whereas cardiovascular disease (HR 1.40, 95% CI 0.89-2.21, P=0.129) and cardiovascular risk factors (HR 1.15, 95% CI 0.73-1.81, P=0.52) were not. We created four separate multivariate cox regression models for troponin, GRACE score, TIMI score, and SOFA score while adjusting for age, use of nonrebreather or high flow nasal cannula, hemoglobin<8.5, suspected or confirmed source of infection, and qSOFA score. GRACE (HR 1.02, 95% CI 1.01-1.04, P<0.01) and SOFA scores (HR 1.19, 95% CI 1.08-1.31, P<0.01) were independently associated with mortality whereas Troponin (HR 1.08, 95% CI 0.63-1.85, P=0.76) and TIMI score (HR 1.02, 95% CI 0.99-1.06, P=0.12) were not. SOFA scores are positively correlated with GRACE scores (r=+0.39). Conclusion: Troponin elevation in COVID-19 patients is mostly due to demand ischemia rather than acute coronary syndrome-related. This was shown by the association of troponin with a higher degree of systemic inflammation and end-organ dysfunction. We recommend SOFA scores and GRACE scores in risk stratifying COVID-19 patients with myocardial injury.