Association of Admission Troponin Levels with Hospitalization and Mortality in COVID-19 Patients

Abstract

Aim: This study aims to identify the association of cardiac Troponin T (cTnT) levels with hospitalization and in-hospital-mortality in patients admitted to emergency department (ED) and diagnosed with COVID-19. Material and Method: We scanned the data of adult patients presenting to the ED of a university hospital within 50 days of the first COVID-19 case admission (March 2020-May 2020) retrospectively. The study group consisted of patients diagnosed with COVID-19 by reverse-transcriptase polymerase-chain reaction, had cTnT test. Demographic and laboratory data, thoracic computed tomography (CT) imaging findings, length of hospital stay were also collected. The study outcomes were patients’ hospitalization status and in-hospital mortality. Results: Out of 36 patients, 9 (25%) were discharged, 20 (55.6%) remained in-patients in the ward, and 7 (19.4%) in intensive care unit. When overall in-patients were compared to discharged patients, a significant difference was observed with regard to age [median (25%-75%)] [60 (45-69) to 28 (26-39.5) years, respectively; p=0.003)], thoracic CT score [6 (0-11) to 0 (0-0.5), respectively; p=0.005], admission cTnT values [5.99 (3.50-15.55) to 3 (3-3.28) ng/L; p=0.012]. Mortality rate among in-patients was 18.5%. In the multivariate cox regression model none of these parameters had a significant effect on survival. Conclusion: The cTnT values of COVID-19 patients are likely to be associated with hospitalization, and mortality. Thoracic CT score was higher in patients who were admitted to intensive care unit. However, neither cTnT values, nor thoracic CT score have a statistically significant effect on survival even if their distributions are different between survived and non-survived groups.

Keywords

• COVID-19
• computed tomography
• emergency department
• hospitalization
• mortality
• troponin

References

1. 1. Fan Y, Jiang M, Gong D, Man C, Chen Y. Cardiac troponin for predicting all-cause mortality in patients with acute ischemic stroke: a meta-analysis. Biosci Rep 2018;38(2):BSR20171178.
2. 2. Ostermann M, Ayis S, Tuddenham E, Lo J, Lei K, Smith J, et al. Cardiac Troponin Release is Associated with Biomarkers of Inflammation and Ventricular Dilatation During Critical Illness. Shock 2017;47(6):702-8.
3. 3. Kaura A, Panoulas V, Glampson B, Davies J, Mulla A, Woods K, et al. Association of Troponin Level and Age With Mortality in 250 000 Patients: Cohort Study Across Five UK Acute Care Centres. BMJ 2019;367:l6055.
4. 4. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020;382(18):1708-1720.
5. 5. T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü, COVID-19 (SARS-CoV-2 Enfeksiyonu) Genel Bilgiler, Epidemiyoloji ve Tanı. Bilimsel Danışma Kurulu Çalışması. (Republic of Turkey Ministry COVID-19 Information Page) Available at: https://covid19.saglik.gov.tr/Eklenti/39551/0/covid-19rehberigenelbilgilerepidemiyolojivetanipdf.pdf (Accessed: 11 January 2021)
6. 6. T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü, COVID-19 (SARS-CoV2 Enfeksiyonu) Rehberi (Bilim Kurulu Çalışması). (Republic of Turkey Ministry COVID-19 Information Page) Available at: https://covid19.saglik.gov.tr/ (Accessed: 11 January 2021)
7. 7. Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology 2020;296(2):E32-E40.
8. 8. Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N, et al. Chest CT Findings in Coronavirus Disease 2019 (COVID-19): Relationship to Duration of Infection. Radiology 2020;295:685–91.

9. 9. Katneni UK, Alexaki A, Hunt RC, Schiller T, DiCuccio M, Buehler PW, et al. Coagulopathy and Thrombosis as a Result of Severe COVID-19 Infection: A Microvascular Focus. Thromb Haemost 2020;120(12):1668-79.
10. 10. Bessière F, Khenifer S, Dubourg J, Durieu I, Lega JC. Prognostic value of troponins in sepsis: a meta-analysis. Intensive Care Med 2013;39(7):1181-9.
11. 11. Pellegrini D, Kawakami R, Guagliumi G, Sakamoto A, Kawai K, Gianatti A, et al. Microthrombi As A Major Cause of Cardiac Injury in COVID-19: A Pathologic Study. Circulation 2021;143(10):1031-42.
12. 12. Republic of Turkey, Ministry of Health. COVID-19 Situation Report Turkey. Available at: https://rm.coe.int/1-turkey-ministry-health-covid-19-report-july-2020/16809ef538. (Accessed: 11 January 2021)
13. 13. Ziebig R, Lun A, Hocher B, Priem F, Altermann C, Asmus G, et al. Renal elimination of troponin T and troponin I. Clin Chem 2003;49(7):1191-3.
14. 14. Chesnaye NC, Szummer K, Bárány P, Heimbürger O, Magin H, Almquist T, et al. Association Between Renal Function and Troponin T Over Time in Stable Chronic Kidney Disease Patients. J Am Heart Assoc 2019;8(21):e013091.
15. 15. Mardani R, Ahmadi Vasmehjani A, Zali F, Gholami A, Mousavi Nasab SD, Kaghazian H, et al. Laboratory Parameters in Detection of COVID-19 Patients with Positive RT-PCR; a Diagnostic Accuracy Study. Arch Acad Emerg Med 2020;8(1):e43.
16. 16. Lippi G, Mattiuzzi C. Hemoglobin value may be decreased in patients with severe coronavirus disease 2019. Hematol Transfus Cell Ther 2020;42(2):116-7.
17. 17. de Sanctis V, Canatan D, Corrons JLV, Karimi M, Daar S, Kattamis C, et al. Preliminary Data on COVID-19 in Patients with Hemoglobinopathies: A Multicentre ICET-A Study. Mediterr J Hematol Infect Dis 2020;12(1):e2020046.
18. 18. Ejigu T, Patel N, Sharma A, Vanjarapu JMR, Nookala V. Packed Red Blood Cell Transfusion as a Potential Treatment Option in COVID-19 Patients With Hypoxemic Respiratory Failure: A Case Report. Cureus 2020;12(6):e8398.
19. 19. Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers DAMPJ, Kant KM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 2020;191:145-7.
20. 20. Francone M, Iafrate F, Masci GM, Coco S, Cilia F, Manganaro L, et al. Chest CT score in COVID-19 patients: correlation with disease severity and short-term prognosis. Eur Radiol 2020;30(12):6808-17.
21. 21. Rapkiewicz AV, Mai X, Carsons SE, Pittaluga S, Kleiner DE, Berger JS, et al. Megakaryocytes and platelet-fibrin thrombi characterize multi-organ thrombosis at autopsy in COVID-19: A case series. EClinicalMedicine 2020;24:100434.