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Gender-Related Prognostic Value of Cardiac Troponin-I in Covid-19 Patients

Year 2021, Volume: 23 Issue: 1, 125 - 131, 30.04.2021
https://doi.org/10.24938/kutfd.883003

Abstract

Objective: Cardiac troponin levels can be increased in many cardiac and non-cardiac diseases. In our study, we aimed to measure the troponin-I level of COVID-19 patients at admission to the hospital to determine its ability to predict the intensive care need and all-cause mortality risk and to evaluate its relationship with gender.
Material and Methods: The study was carried out retrospectively by analyzing the electronic medical records of COVID-19 patients who were hospitalized in our hospital between April 1, 2020 and February 1, 2021 and were tested for cardiac troponin-I in the first 24 hours. Statistical analysis was performed for all variables investigated in the study.
Results: A total of 362 COVID patients were included in the study. Cardiac troponin-I level was abnormal in 90 patients. In 39 of the patients, the need for intensive care developed. Cardiac troponin-I level was abnormal in 17 of the patients in need of intensive care and in 73 of the patients who were not followed up in intensive care unit. It was observed that the need for intensive care was 71% higher in male gender and the negative predictive value of cardiac troponin-I level was 87.5%. Cardiac troponin-I level was abnormal in 11 of the patients who died and in 79 of the patients who survived. It was determined that the mortality risk was 75% higher in the male gender and the negative predictive value of cardiac troponin-I level was 91.7%.
Conclusion: In this study, it was observed that normal troponin level in the first 24 hours of hospitalization has a high negative predictive value for mortality in men and women. It was thought that cardiac troponin-I levels could be a guiding biomarker for clinicians in the follow-up of COVID-19 patients, and patients with normal cardiac troponin-I could be discharged earlier than other patients.

References

  • 1. Morrow DA, Cannon CP, Rifai N, Frey MJ, Vicari R, Lakkis N et al. Ability of minor elevations of troponins I and T to predict benefit from an early invasive strategy in patients with unstable angina and non-ST elevation myocardial infarction: results from a randomized trial. JAMA. 2001;286(19):2405-12.
  • 2. Lazzeri C, Bonizzoli M, Cianchi G, Gensini GF, Peris A. Troponin I in the intensive care unit setting: from the heart to the heart. Intern Emerg Med. 2008;3(1):9-16.
  • 3. Antman EM, Tanasijevic MJ, Thompson B, Schactman M, McCabe CH, Cannon CP et al. Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med. 1996;335(18):1342-9.
  • 4. Ozsu S, Yilmaz G, Yilmaz I, Oztuna F, Bulbul Y, Ozlu T. C-reactive protein alone or combined with cardiac troponin T for risk stratification of respiratory intensive care unit patients. Respir Care. 2011;56(7):1002-8.
  • 5. Lorson W, Veve MP, Heidel E, Shorman MA. Elevated troponin level as a predictor of inpatient mortality in patients with infective endocarditis in the Southeast United States. BMC Infect Dis. 2020;20(1):24.
  • 6. Sandoval Y, Januzzi JL Jr, Jaffe AS. Cardiac troponin for assessment of myocardial ınjury in COVID-19: JACC review topic of the week. J Am Coll Cardiol. 2020;76(10):1244-58.
  • 7. Thygesen K, Mair J, Katus H, Plebani M, Venge P, Collinson P et al. Recommendations for the use of cardiac troponin measurement in acute cardiac care. Eur Heart J. 2010;31(18):2197‐204.
  • 8. Agewall S, Giannitsis E, Jernberg T, Katus H. Troponin elevation in coronary vs. non-coronary disease. Eur Heart J. 2011;32(4):404-11.
  • 9. Kociol R, Pang P, Gheorghiade M, Fonarow G, O'Connor C, Felker G. Troponin elevation in heart failure prevalence, mechanisms, and clinical implications. J Am Coll Cardiol. 2010;56(14):1071‐8.
  • 10. Freda B, Tang W, Van Lente F, Peacock W, Francis G. Cardiac troponins in renal insufficiency: review and clinical implications. J Am Coll Cardiol. 2002;40(12):2065‐71.
  • 11. Cordeanu EM, Duthil N, Severac F, Lambach H, Tousch J, Jambert L et al. Prognostic value of troponin elevation in COVID-19 hospitalized patients. J Clin Med. 2020;9(12):4078.
  • 12. Majure DT, Gruberg L, Saba SG, Kvasnovsky C, Hirsch JS, Jauhar R; Northwell Health COVID-19 Research Consortium. Usefulness of elevated troponin to predict death in patients with COVID-19 and myocardial injury. Am J Cardiol. 2021;138:100-6.
  • 13. Du RH, Liang LR, Yang CQ, Wang W, Cao TZ, Li M et al. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study. Eur Respir J. 2020;55(5):2000524.
  • 14. Gebhard C, Regitz-Zagrosek V, Neuhauser HK, Morgan R, Klein SL. Impact of sex and gender on COVID-19 outcomes in Europe. Biol Sex Differ. 2020;11(1):29.
  • 15. Walter LA, McGregor AJ. Sex- and gender-specific observations and implications for COVID-19. West J Emerg Med. 2020;21(3):507-9.

COVID-19 HASTALARINDA KARDİYAK TROPONİN-I’NIN CİNSİYET İLİŞKİLİ PROGNOSTİK DEĞERİ

Year 2021, Volume: 23 Issue: 1, 125 - 131, 30.04.2021
https://doi.org/10.24938/kutfd.883003

Abstract

Amaç: Kardiyak troponinler kardiyak ve non-kardiak birçok hastalıkta yükselebilmektedir. Çalışmamızda COVID-19 hastalarının hastaneye kabulünde kardiyak troponin-I seviyesinin yoğun bakım ihtiyacı ve tüm nedenlere bağlı mortalite riskini önceden tahmin etme kabiliyetinin belirlenmesi ve cinsiyet ile ilişkisinin değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntemler: Çalışma, hastanemizde 1 Nisan 2020 ile 1 Şubat 2021 tarihleri arasında yatırılan ve ilk 24 saatteki kardiyak troponin-I bakılmış COVID-19 hastalarının elektronik tıbbi kayıtlarının retrospektif olarak analiz edilmesi ile yapıldı. Çalışmada araştırılan tüm değişkenler için istatistiksel analiz yapıldı.
Bulgular: Çalışmaya toplam 362 COVID hastası dahil edildi. 90 hastada kardiyak troponin-I düzeyi anormaldi. Hastaların 39'unda yoğun bakım ihtiyacı gelişti. Yoğun bakıma ihtiyaç duyan hastaların 17'sinde, yoğun bakım ünitesinde takip edilmeyen hastaların 73'ünde kardiyak troponin-I düzeyi anormaldi. Erkek cinsiyette yoğun bakım ihtiyacının %71 daha fazla olduğu ve kardiyak troponin-I düzeyinin negatif prediktif değerinin %87,5 olduğu görüldü. Kardiyak troponin-I düzeyi ölen hastaların 11'inde, sağ kalan hastaların 79'unda anormaldi. Erkek cinsiyette ölüm riskinin %75 daha yüksek olduğu ve kardiyak troponin-I düzeyinin negatif prediktif değerinin %91,7 olduğu belirlendi.
Sonuç: Bu çalışmada, hastaneye yatışın ilk 24 saatindeki normal troponin seviyesinin, mortalite için kadın ve erkek cinsiyette yüksek negatif prediktif değere sahip olduğu görülmüştür. Kardiyak troponin-I seviyelerinin COVID-19 hasta takibinde klinisyenlere yol gösterici bir biyobelirteç olabileceği ve kardiyak troponin-I seviyesi normal olan hastaların diğer hastalara göre daha erken taburcu edilebileceği düşünülmüştür.

References

  • 1. Morrow DA, Cannon CP, Rifai N, Frey MJ, Vicari R, Lakkis N et al. Ability of minor elevations of troponins I and T to predict benefit from an early invasive strategy in patients with unstable angina and non-ST elevation myocardial infarction: results from a randomized trial. JAMA. 2001;286(19):2405-12.
  • 2. Lazzeri C, Bonizzoli M, Cianchi G, Gensini GF, Peris A. Troponin I in the intensive care unit setting: from the heart to the heart. Intern Emerg Med. 2008;3(1):9-16.
  • 3. Antman EM, Tanasijevic MJ, Thompson B, Schactman M, McCabe CH, Cannon CP et al. Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med. 1996;335(18):1342-9.
  • 4. Ozsu S, Yilmaz G, Yilmaz I, Oztuna F, Bulbul Y, Ozlu T. C-reactive protein alone or combined with cardiac troponin T for risk stratification of respiratory intensive care unit patients. Respir Care. 2011;56(7):1002-8.
  • 5. Lorson W, Veve MP, Heidel E, Shorman MA. Elevated troponin level as a predictor of inpatient mortality in patients with infective endocarditis in the Southeast United States. BMC Infect Dis. 2020;20(1):24.
  • 6. Sandoval Y, Januzzi JL Jr, Jaffe AS. Cardiac troponin for assessment of myocardial ınjury in COVID-19: JACC review topic of the week. J Am Coll Cardiol. 2020;76(10):1244-58.
  • 7. Thygesen K, Mair J, Katus H, Plebani M, Venge P, Collinson P et al. Recommendations for the use of cardiac troponin measurement in acute cardiac care. Eur Heart J. 2010;31(18):2197‐204.
  • 8. Agewall S, Giannitsis E, Jernberg T, Katus H. Troponin elevation in coronary vs. non-coronary disease. Eur Heart J. 2011;32(4):404-11.
  • 9. Kociol R, Pang P, Gheorghiade M, Fonarow G, O'Connor C, Felker G. Troponin elevation in heart failure prevalence, mechanisms, and clinical implications. J Am Coll Cardiol. 2010;56(14):1071‐8.
  • 10. Freda B, Tang W, Van Lente F, Peacock W, Francis G. Cardiac troponins in renal insufficiency: review and clinical implications. J Am Coll Cardiol. 2002;40(12):2065‐71.
  • 11. Cordeanu EM, Duthil N, Severac F, Lambach H, Tousch J, Jambert L et al. Prognostic value of troponin elevation in COVID-19 hospitalized patients. J Clin Med. 2020;9(12):4078.
  • 12. Majure DT, Gruberg L, Saba SG, Kvasnovsky C, Hirsch JS, Jauhar R; Northwell Health COVID-19 Research Consortium. Usefulness of elevated troponin to predict death in patients with COVID-19 and myocardial injury. Am J Cardiol. 2021;138:100-6.
  • 13. Du RH, Liang LR, Yang CQ, Wang W, Cao TZ, Li M et al. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study. Eur Respir J. 2020;55(5):2000524.
  • 14. Gebhard C, Regitz-Zagrosek V, Neuhauser HK, Morgan R, Klein SL. Impact of sex and gender on COVID-19 outcomes in Europe. Biol Sex Differ. 2020;11(1):29.
  • 15. Walter LA, McGregor AJ. Sex- and gender-specific observations and implications for COVID-19. West J Emerg Med. 2020;21(3):507-9.
There are 15 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Articles
Authors

Aydın Kant 0000-0003-2914-2478

Ercan Aydın 0000-0001-8743-3762

Hülya Kılıç Yılmaz This is me 0000-0002-2724-1897

Gürdal Yılmaz 0000-0002-5967-9615

Publication Date April 30, 2021
Submission Date February 19, 2021
Published in Issue Year 2021 Volume: 23 Issue: 1

Cite

APA Kant, A., Aydın, E., Kılıç Yılmaz, H., Yılmaz, G. (2021). COVID-19 HASTALARINDA KARDİYAK TROPONİN-I’NIN CİNSİYET İLİŞKİLİ PROGNOSTİK DEĞERİ. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, 23(1), 125-131. https://doi.org/10.24938/kutfd.883003
AMA Kant A, Aydın E, Kılıç Yılmaz H, Yılmaz G. COVID-19 HASTALARINDA KARDİYAK TROPONİN-I’NIN CİNSİYET İLİŞKİLİ PROGNOSTİK DEĞERİ. Kırıkkale Uni Med J. April 2021;23(1):125-131. doi:10.24938/kutfd.883003
Chicago Kant, Aydın, Ercan Aydın, Hülya Kılıç Yılmaz, and Gürdal Yılmaz. “COVID-19 HASTALARINDA KARDİYAK TROPONİN-I’NIN CİNSİYET İLİŞKİLİ PROGNOSTİK DEĞERİ”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 23, no. 1 (April 2021): 125-31. https://doi.org/10.24938/kutfd.883003.
EndNote Kant A, Aydın E, Kılıç Yılmaz H, Yılmaz G (April 1, 2021) COVID-19 HASTALARINDA KARDİYAK TROPONİN-I’NIN CİNSİYET İLİŞKİLİ PROGNOSTİK DEĞERİ. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 23 1 125–131.
IEEE A. Kant, E. Aydın, H. Kılıç Yılmaz, and G. Yılmaz, “COVID-19 HASTALARINDA KARDİYAK TROPONİN-I’NIN CİNSİYET İLİŞKİLİ PROGNOSTİK DEĞERİ”, Kırıkkale Uni Med J, vol. 23, no. 1, pp. 125–131, 2021, doi: 10.24938/kutfd.883003.
ISNAD Kant, Aydın et al. “COVID-19 HASTALARINDA KARDİYAK TROPONİN-I’NIN CİNSİYET İLİŞKİLİ PROGNOSTİK DEĞERİ”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 23/1 (April 2021), 125-131. https://doi.org/10.24938/kutfd.883003.
JAMA Kant A, Aydın E, Kılıç Yılmaz H, Yılmaz G. COVID-19 HASTALARINDA KARDİYAK TROPONİN-I’NIN CİNSİYET İLİŞKİLİ PROGNOSTİK DEĞERİ. Kırıkkale Uni Med J. 2021;23:125–131.
MLA Kant, Aydın et al. “COVID-19 HASTALARINDA KARDİYAK TROPONİN-I’NIN CİNSİYET İLİŞKİLİ PROGNOSTİK DEĞERİ”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, vol. 23, no. 1, 2021, pp. 125-31, doi:10.24938/kutfd.883003.
Vancouver Kant A, Aydın E, Kılıç Yılmaz H, Yılmaz G. COVID-19 HASTALARINDA KARDİYAK TROPONİN-I’NIN CİNSİYET İLİŞKİLİ PROGNOSTİK DEĞERİ. Kırıkkale Uni Med J. 2021;23(1):125-31.

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