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.

中文翻译：

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心肌肌钙蛋白对 COVID-19 患者 60 天死亡率和主要不良事件的预后价值

背景

2019 年冠状病毒病 (COVID-19) 疾病严重程度的可变性令临床医生感到困惑，并促使人们努力更好地预测谁将从快速干预中受益。一种有前途的院内发病率和死亡率生物标志物是心肌肌钙蛋白 (cTn)。

方法

对美国伊利诺伊州拉什大学系统录取的 1331 名 COVID-19 成年患者进行了回顾性研究。入院期间未进行 cTn 测量或有终末期肾病或 5 期慢性肾病病史的患者被排除在外。使用针对基线特征、预先存在的合并症和其他炎症实验室标志物调整的逻辑回归，cTn 被评估为 60 天死亡率和严重 COVID-19 感染的预测因子，包括 60 天死亡率、需要重症监护病房，或需要无创正压通气或插管。

结果

共有 772 名患者符合纳入标准。其中，69 人 (8.9%) 有轻度 cTn 升高（> 1 至 < 2x 正常上限 (ULN)），46 人 (6.0%) 有严重 cTn 升高（≥ 2x ULN）。无论基线特征、合并症和初始 c 反应蛋白、乳酸脱氢酶和铁蛋白如何，与正常 cTn 组相比，轻度 cTn 升高和重度 cTn 升高是严重 COVID-19 感染的预测因子（调整后的 OR [aOR] aOR 3.00 [CI：1.51 – 6.29]，P < 0.01；aOR 9.96 [CI：2.75 – 64.23]，P < 0.01）；严重的 cTn 升高是院内死亡率（aOR 2.42 [CI：1.10 – 5.21]，P < 0.05）和 60 天死亡率（aOR 2.45 [CI：1.13 – 5.25]，P < 0.05）的预测因子。

结论

在我们的队列中，轻度和重度初始 cTn 升高都是严重 COVID-19 感染的预测因子，而只有重度 cTn 升高可预测 60 天死亡率。住院时的第一个 cTn 值是 COVID-19 疾病严重程度和死亡率的一个有价值的纵向预测指标。