Abstract
Background: Limited data exist on high-sensitivity cardiac troponin (hs-cTn) for risk-stratification in COVID-19.
Methods: We conducted a multicenter, retrospective, observational, US-based study of COVID-19 patients undergoing hs-cTnT. Outcomes included short-term mortality (in-hospital and 30-days post-discharge) and a composite of major adverse events, including respiratory failure requiring mechanical ventilation, cardiac arrest, and shock within the index presentation and/or mortality during the index hospitalization or within 30-days post-discharge.
Results: Among 367 COVID-19 patients undergoing hs-cTnT, myocardial injury was identified in 46%. They had a higher risk for mortality (20% vs 12%, P < 0.0001; unadjusted HR 4.44, 95% CI 2.13-9.25, P < 0.001) and major adverse events (35% vs. 11%, P < 0.0001; unadjusted OR 4.29, 95% CI 2.50-7.40, P < 0.0001). Myocardial injury was associated with major adverse events (adjusted OR 3.84, 95% CI 2.00-7.36, P < 0.0001) but not mortality. Baseline (adjusted OR 1.003, 95% CI 1.00-1.007, P = 0.047) and maximum (adjusted OR 1.005, 95% CI 1.001-1.009, P = 0.0012) hs-cTnT were independent predictors of major adverse events. Most (95%) increases were due to myocardial injury, with 5% (n = 8) classified as type 1 or 2 myocardial infarction. A single hs-cTnT <6 ng/L identified 26% of patients without mortality, with a 94.9% (95% CI 87.5-98.6) negative predictive value and 93.1% sensitivity (95% CI 83.3-98.1) for major adverse events in those presenting to the ED.
Conclusions: Myocardial injury is frequent and prognostic in COVID-19. While most hs-cTnT increases are modest and due to myocardial injury, they have important prognostic implications. A single hs-cTnT <6 ng/L at presentation may facilitate the identification of patients with a favorable prognosis.
Keywords: COVID-19; high sensitivity cardiac troponin T; myocardial infarction; myocardial injury; risk stratification.
【저자키워드】 COVID-19, risk stratification., myocardial injury, Myocardial infarction, high sensitivity cardiac troponin T, 【초록키워드】 Respiratory failure, Mortality, Prognosis, mechanical ventilation, Hospitalization, Cardiac arrest, Predictive value, cardiac troponin, adverse events, risk stratification, sensitivity, Shock, myocardial injury, adverse event, Patient, troponin T, Myocardial infarction, multicenter, prognostic, retrospective, Injury, independent predictors, Composite, COVID-19 patient, Negative predictive value, In-hospital, Implications, higher risk, 95% CI, cTnT, while, MOST, Myocardial, conducted, facilitate, adjusted, increase, presenting, independent predictor, Limited, 【제목키워드】 detection, cardiac,