Troponin Elevation a Marker of Mortality in COVID-19 Patients

ABSTRACT

Introduction: Troponin I test has been used as a biomarker for the diagnosis of ACS since 1965. Troponin I has a prognostic value in hospitalized patients with non-cardiac diagnosis. In 2019, The WHO declared COVID-19 as a deadly infectious disease. Given the global impact of this disease, there is a need to identify biomarkers associated with mortality in hospitalized patients. Biomarkers associated with mortality are an important tool for escalation of care in patients deemed at risk of clinical decompensation. The following study demonstrated an association between troponin I elevation and increased mortality among COVID-19 patients. Hypothesis: We sought to determine if Troponin I elevation within 24 hours of admission is associated with increased mortality in COVID-19 patients. Method(s) In a retrospective, multicenter study at Atlantic Health System in New Jersey, we analyzed 10,980 first-drawn troponin I values within 24 hours of admission in 34,625 patients between 12/2020-02/2021. Data was analyzed using logistic regression and cox proportional hazard ratio to determine our primary outcome, which is the association of troponin elevation and mortality among COVID-19 patients. Result(s) The characteristic of 10,980 patients that survived COVID-19 and patients that expired due to COVID-19 during the hospitalization were analyzed. Total of 6,083 were male and 4897 were females. In the survival group, the mean age was 60 with STD 17.2, while in the deceased group the mean age was 74 with STD 13. Logistic regression revealed thatpatients with elevated troponin have increased odds of death compared to others with non-elevated troponin levels (Point estimate 3.301665). Females with elevated troponin have greater odds of death than males with elevated troponin (point estimate 4.484406 in females vs point estimate men 3.301665). Patients with elevated troponin have increased hazard by a factor of 1.78 or increased chance of death by 78%. As supporting evidence of our hypothesis patients with an elevated troponin in the first 24 hours have 3.74 increase odds of death. Conclusion(s) In conclusion, Troponin I elevation within 24 hours of admission is associated with increased mortality in hospitalized COVID-19 patients with 3.7 increase odds of death.