Abstract
Background: The variability of coronavirus disease 2019 (COVID-19) illness severity has puzzled clinicians and has sparked efforts to better predict who would benefit from rapid intervention. One promising biomarker for in-hospital morbidity and mortality is cardiac troponin (cTn).
Methods: A retrospective study of 1331 adult patients with COVID-19 admitted to the Rush University System in Illinois, USA was performed. Patients without cTn measurement during their admission or a history of end stage renal disease or stage 5 chronic kidney disease were excluded. Using logistic regression adjusted for baseline characteristics, pre-existing comorbidities, and other laboratory markers of inflammation, cTn was assessed as a predictor of 60-day mortality and severe COVID-19 infection, consisting of a composite of 60-day mortality, need for intensive care unit, or requiring non-invasive positive pressure ventilation or intubation.
Results: A total of 772 patients met inclusion criteria. Of these, 69 (8.9%) had mild cTn elevation (> 1 to < 2x upper limit of normal (ULN)) and 46 (6.0%) had severe cTn elevation (≥ 2x ULN). Regardless of baseline characteristics, comorbidities, and initial c-reactive protein, lactate dehydrogenase, and ferritin, when compared to the normal cTn group, mild cTn elevation and severe cTn elevation were predictors of severe COVID-19 infection (adjusted OR [aOR] aOR 3.00 [CI: 1.51 – 6.29], P < 0.01; aOR 9.96 [CI: 2.75 – 64.23], P < 0.01, respectively); severe cTn elevation was a predictor of in-hospital mortality (aOR 2.42 [CI: 1.10 – 5.21], P < 0.05) and 60-day mortality (aOR 2.45 [CI: 1.13 – 5.25], P < 0.05).
Conclusion: In our cohort, both mild and severe initial cTn elevation were predictors of severe COVID-19 infection, while only severe cTn elevation was predictive of 60-day mortality. First cTn value on hospitalization is a valuable longitudinal prognosticator for COVID-19 disease severity and mortality.
Keywords: Biomarker; COVID-19; Mortality; SARS-CoV-2; Troponin.
【저자키워드】 COVID-19, SARS-CoV-2, Biomarker, Mortality, troponin., 【초록키워드】 coronavirus disease, Inflammation, Coronavirus disease 2019, Biomarker, intensive care, Hospitalization, Comorbidities, intensive care unit, intubation, C-reactive protein, troponin, ferritin, Intervention, Chronic kidney disease, lactate dehydrogenase, Laboratory, COVID-19 disease, cardiac troponin, Retrospective study, Protein, Cohort, COVID-19 infection, Patient, Kidney disease, Logistic regression, Mild, morbidity and mortality, predictor, USA, renal disease, university, disease, Admission, predict, in-hospital mortality, marker, Lactate, Composite, Illness severity, Predictive, positive pressure, In-hospital, non-invasive positive pressure ventilation, Severe COVID-19 Infection, Non-invasive, clinician, baseline characteristics, Variability, inclusion criteria, Elevation, COVID-19 disease severity, effort, renal, pressure ventilation, System, benefit, limit, positive pressure ventilation, initial, was performed, adjusted, cTn, patients with COVID-19, ULN, were excluded, 【제목키워드】 adverse event, COVID-19 patient, Prognostic value,