Dataset Information

The peak levels of highly sensitive troponin I predicts in-hospital mortality in COVID-19 patients with cardiac injury: a retrospective study.

ABSTRACT:

Aims

To investigate the association between levels of highly sensitive troponin I (hs-troponin I) and mortality in novel coronavirus disease 2019 (COVID-19) patients with cardiac injury.

Methods and results

We retrospectively reviewed the medical records of all COVID-19 patients with increased levels of hs-troponin I from two hospitals in Wuhan, China. Demographic information, laboratory test results, cardiac ultrasonographic findings, and electrocardiograms were collected, and their predictive value on in-hospital mortality was explored using multivariable logistic regression. Of 1500 patients screened, 242 COVID-19 patients were enrolled in our study. Their median age was 68?years, and (48.8%) had underlying cardiovascular diseases. One hundred and seventy-six (72.7%) patients died during hospitalization. Multivariable logistic regression showed that C-reactive protein (>75.5?mg/L), D-dimer (>1.5??g/mL), and acute respiratory distress syndrome were risk factors of mortality, and the peak hs-troponin I levels (>259.4?pg/mL) instead of the hs-troponin I levels at admission was predictor of death. The area under the receiver operating characteristic curve of the peak levels of hs-troponin I for predicting in-hospital mortality was 0.79 (95% confidence interval, 0.73-0.86; sensitivity, 0.80; specificity, 0.72; P?ConclusionOur results demonstrated that the risk of in-hospital death among COVID-19 patients with cardiac injury can be predicted by the peak levels of hs-troponin I during hospitalization and was significantly associated with oxygen supply-demand mismatch, inflammation, and coagulation.

SUBMITTER: Wang Y

PROVIDER: S-EPMC7665398 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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The peak levels of highly sensitive troponin I predicts in-hospital mortality in COVID-19 patients with cardiac injury: a retrospective study.

Wang Yaxin Y Shu Huaqing H Liu Hong H Li Xia X Zhou Xing X Zou Xiaojing X Pan Shangwen S Xu Jiqian J Xu Dan D Zhao Xin X Yang Xiaobo X Yu Yuan Y Yuan Yin Y Qi Hong H Wang Qiongya Q Shang You Y

European heart journal. Acute cardiovascular care 20210301 1

<h4>Aims</h4>To investigate the association between levels of highly sensitive troponin I (hs-troponin I) and mortality in novel coronavirus disease 2019 (COVID-19) patients with cardiac injury.<h4>Methods and results</h4>We retrospectively reviewed the medical records of all COVID-19 patients with increased levels of hs-troponin I from two hospitals in Wuhan, China. Demographic information, laboratory test results, cardiac ultrasonographic findings, and electrocardiograms were collected, and th ...[more]

PMID: 33620438

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Project description:Interest in the use of cardiac troponin T (cTnT) and cardiac troponin I (cTnI) has expanded from diagnosis of acute myocardial infarction to risk assessment for morbidity and mortality. Although cTnT and cTnI were shown to have equivalent diagnostic performance in the setting of suspected acute myocardial infarction, potential prognostic differences are largely unexplored.The aim of this study is to quantify and compare the relationship between cTnT and cTnI, and cardiovascular and all-cause mortality in the general population.Medline, Embase, and the Cochrane Library (from inception through October 2016) were searched for prospective observational cohort studies reporting on the prognostic value of basal high-sensitive cTnT and/or cTnI levels on cardiovascular and all-cause mortality in the general population. Data on study characteristics, participants' characteristics, outcome parameters, and quality [according to the Effective Public Health Practice Project (EPHPP) "Quality Assessment Tool For Quantitative Studies] were retrieved. Hazard ratios per standard deviation increase in basal cardiac troponin level (HR per 1-SD; retrieved from the included articles or estimated) were pooled using a random-effects model.On a total of 2585 reviewed citations, 11 studies, with data on 65,019 participants, were included in the meta-analysis. Random effects pooling showed significant associations between basal cardiac troponin levels and HR for cardiovascular and all-cause mortality [HR per 1-SD 1.29 (95% confidence interval, 95% CI, 1.20-1.38) and HR per 1-SD 1.18 (95% CI, 1.11-1.26), respectively]. Stratified analyses showed higher HRs for cTnT than cTnI [cardiovascular mortality: cTnT HR per 1-SD 1.37 (95% CI, 1.23-1.52); and cTnI HR per 1-SD 1.21 (95% CI, 1.16-1.26); all-cause mortality: cTnT HR per 1-SD 1.31 (955 CI, 1.13-1.53); and cTnI HR per 1-SD 1.14 (95% CI, 1.06-1.22)]. These differences were significant (P < 0.01) in meta-regression analyses for cardiovascular mortality but did not reach statistical significance for all-cause mortality.Elevated, basal cTnT, and cTnI show robust associations with an increased risk of cardiovascular and all-cause mortality during follow-up in the general population.Systematic review registration number PROSPERO CRD42014006964.

Project description:ContextDetectable levels of cardiac troponin T (cTnT) are strongly associated with structural heart disease and increased risk of death and adverse cardiovascular events; however, cTnT is rarely detectable in the general population using standard assays.ObjectivesTo determine the prevalence and determinants of detectable cTnT in the population using a new highly sensitive assay and to assess whether cTnT levels measured with the new assay associate with pathological cardiac phenotypes and subsequent mortality.Design, setting, and participantsCardiac troponin T levels were measured using both the standard and the highly sensitive assays in 3546 individuals aged 30 to 65 years enrolled between 2000 and 2002 in the Dallas Heart Study, a multiethnic, population-based cohort study. Mortality follow-up was complete through 2007. Participants were placed into 5 categories based on cTnT levels.Main outcome measuresMagnetic resonance imaging measurements of cardiac structure and function and mortality through a median of 6.4 (interquartile range, 6.0-6.8) years of follow-up.ResultsIn Dallas County, the prevalence of detectable cTnT (≥0.003 ng/mL) was 25.0% (95% confidence interval [CI], 22.7%-27.4%) with the highly sensitive assay vs 0.7% (95% CI, 0.3%-1.1%) with the standard assay. Prevalence was 37.1% (95% CI, 33.3%-41.0%) in men vs 12.9% (95% CI, 10.6%-15.2%) in women and 14.0% (95% CI, 11.2%-16.9%) in participants younger than 40 years vs 57.6% (95% CI, 47.0%-68.2%) in those 60 years and older. Prevalence of left ventricular hypertrophy increased from 7.5% (95% CI, 6.4%-8.8%) in the lowest cTnT category (<0.003 ng/mL) to 48.1% (95% CI, 36.7%-59.6%) in the highest (≥0.014 ng/mL) (P < .001); prevalence of left ventricular systolic dysfunction and chronic kidney disease also increased across categories (P < .001 for each). During a median follow-up of 6.4 years, there were 151 total deaths, including 62 cardiovascular disease deaths. All-cause mortality increased from 1.9% (95% CI, 1.5%-2.6%) to 28.4% (95% CI, 21.0%-37.8%) across higher cTnT categories (P < .001). After adjustment for traditional risk factors, C-reactive protein level, chronic kidney disease, and N-terminal pro-brain-type natriuretic peptide level, cTnT category remained independently associated with all-cause mortality (adjusted hazard ratio, 2.8 [95% CI, 1.4-5.2] in the highest category). Adding cTnT categories to the fully adjusted mortality model modestly improved model fit (P = .02) and the integrated discrimination index (0.010 [95% CI, 0.002-0.018]; P = .01).ConclusionIn this population-based cohort, cTnT detected with a highly sensitive assay was associated with structural heart disease and subsequent risk for all-cause mortality.

Project description:PurposeThe importance of troponin elevation at stroke presentation remains uncertain. We aimed to assess whether baseline ultrasensitive Troponin I (hs-TnI) predicts cardiac complications and outcome in acute stroke patients.MethodStroke patients admitted within 6 h were consecutively enrolled from May 2013 to March 2014. Blood samples were taken at admission to determine hs-TnI by chemiluminescent microparticle immunoassay. hs-TnI > 34.2 pg/ml (male) and >15.6 pg/ml (female) were considered elevated. Complications during in-hospital stay and outcome at 90 days were prospectively recorded. Independent predictors of cardiac complications (heart failure and acute coronary syndrome) and mortality were determined by logistic regression. The additional predictive value of hs-TnI was evaluated by integrated discrimination improvement index. A subanalysis was performed after excluding patients with previous cardiac diseases.FindingsFrom 174 patients, 39(22%) had elevated hs-TnI, having these patients higher incidence of cardiac complications (57% versus 19%, p = 0.004). hs-TnI was an independent predictor of cardiac complications (OR = 16.1 (1.7-150.3)) together with diastolic blood pressure (OR = 0.92 (0.86-0.99)). Addition of hs-TnI to clinical variables significantly improved discrimination (IDI = 15.2% (7.8-22.7)). Subanalysis in patients without previous cardiac diseases showed similar results. Elevated hs-TnI was independently associated with 90 days mortality (OR = 3.6 (1.3-9.4)), but addition of hs-TnI to clinical data did not result in an increased discrimination.DiscussionThe present study confers hs-TnI a 2b level of evidence as a diagnostic tool to predict cardiac complications in stroke. Absence of serial hs-TnI measurements and limited sample size are the main weaknesses of the study.ConclusionPatients with elevated baseline hs-TnI showed a higher frequency of cardiac complications and a higher mortality. Measurement of hs-TnI in acute stroke might be useful to identify patients at a high risk of cardiac complications and death.

Project description:BackgroundHigh sensitive cardiac troponin T (hsTnT) is a widely used biomarker of myocardial injury. Along with other high sensitive troponins, HsTnT can predict mortality in both cardiac and non-cardiac surgery. The aim of this study was to determine the association between hsTnT serum elevations in the immediate postoperative period until 120 h after cardiac surgery and the occurrence of in-hospital mortality compared to the Simplified Acute Physiology Score 3 (SAPS3). Additionally, we identified an ideal hsTnT serum threshold to predict in-hospital mortality.MethodsWe performed a retrospective single-institutional cohort analysis of 2179 patients undergoing cardiac surgery with cardiopulmonary bypass from 2013 to 2021. Logistic regression analysis was used to investigate an association of hsTnT at various time points and in-hospital mortality. The model was adjusted for relevant covariates including SAPS3, lactate and administered norepinephrine dosage. ROC analysis was performed to estimate the accuracy to predict mortality by serum hsTnT concentrations. This prediction was compared to the SAPS3 score. An ideal cutoff of hsTnT concentration was calculated by means of Youden index.ResultsIn total 7576 troponins were measured at the predefined timepoints. 100 (4.59%) patients died during the hospital stay. The fourth hsTnT on d3 (at 96-120 h postoperatively) showed the highest association with in-hospital death (OR 1.56; 95% CI (1.39-1.76); p < 0.001). This finding persisted after multivariable adjustment (aOR 1.34; 95% CI (1.18-1.53); p < 0.001). In contrast, the third hsTnT on d2 (at 48-72 h postoperatively) showed the best discrimination for in-hospital mortality (AUC 82.75%; 95% CI (0.77-0.89). The prediction by the third hsTnT was comparable to the in-hospital mortality prediction by SAPS3 (AUC 79.36%; 95% CI (0.73-0.85); p = 0.056). The optimal cutoff for the third hsTnT was calculated to be 1264 ng/L (Sensitivity 0.62; Specificity 0.88).ConclusionElevated hsTnT after cardiac surgery was associated with an increased risk of in-hospital mortality. HsTnT measured on postoperative day 2 and 3 were most accurate to predict in-hospital mortality. The prediction of in-hospital mortality using hsTNT is comparable to mortality prediction using the SAPS3 score. HsTnT serum levels currently recommended to establish clinically important periprocedural myocardial injury are lower than thresholds identified in this study.

Dataset Information

The peak levels of highly sensitive troponin I predicts in-hospital mortality in COVID-19 patients with cardiac injury: a retrospective study.

Aims

Methods and results

Publications

The peak levels of highly sensitive troponin I predicts in-hospital mortality in COVID-19 patients with cardiac injury: a retrospective study.

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