BACKGROUND Increases in cardiac troponin (cTn) in coronavirus disease 2019 (COVID-19) have been associated with worse prognosis. Nonetheless, data about the significance of cTn in elderly subjects with COVID-19 are lacking. METHODS From a registry of consecutive patients with COVID-19 admitted to a hub hospital in Italy from 25/02/2020 to 03/07/2020, we selected those ≥ 60 year-old and with cTnI measured within three days from the molecular diagnosis of SARSCoV-2 infection. When available, a second cTnI value within 48 h was also extracted. The relationship between increased cTnI and all-cause in-hospital mortality was evaluated by a Cox regression model and restricted cubic spline functions with three knots. RESULTS Of 343 included patients (median age: 75.0 (68.0−83.0) years, 34.7% men), 88 (25.7%) had cTnI above the upper-reference limit (0.046 μg/L). Patients with increased cTnI had more comorbidities, greater impaired respiratory exchange and higher inflammatory markers on admission than those with normal cTnI. Furthermore, they died more (73.9% vs. 37.3%, P < 0.001) over 15 (6−25) days of hospitalization. The association of elevated cTnI with mortality was confirmed by the adjusted Cox regression model (HR = 1.61, 95%CI: 1.06−2.52, P = 0.039) and was linear until 0.3 μg/L, with a subsequent plateau. Of 191 (55.7%) patients with a second cTnI measurement, 49 (25.7%) had an increasing trend, which was not associated with mortality (univariate HR = 1.39, 95%CI: 0.87−2.22, P = 0.265). CONCLUSIONS In elderly COVID-19 patients, an initial increase in cTn is common and predicts a higher risk of death. Serial cTn testing may not confer additional prognostic information.
Prevalence and prognostic value of cardiac troponin in elderly patients hospitalized for COVID-19
Di Biagio A.;Vena A.;Arboscello E.;Mora S.;Giacomini M.;Pelosi P.;Bassetti M.;Ameri P.;Porto I.;Alessandrini A.;Camera M.;Dentone C.;Ferrazin A.;Mazzarello G.;Mikulska M.;Giacobbe D. R.;Taramasso L.;Balletto E.;Schenone E.;Dettori S.;Labate L.;Magnasco L.;Mirabella M.;Pincino R.;Sarteschi G.;Sepulcri C.;Tutino S.;Pontremoli R.;Beccati V.;Leoncini G.;Pitto P.;Salam K.;Gratarola A.;Bixio M.;Balestra A.;Bardi N.;Boccafogli R.;Caserza F.;Cenni E.;Cortese P.;Cuttone G.;Feltrin S.;Giovinazzo S.;Giuntini P.;Perazzo T.;Pescetelli F.;Schenone F.;Sottano M.;Brunetti I.;Loconte M.;Ball L.;Battaglini D.;Robba C.;Patroniti N.;Perazzo F.;Bovio M.;Cutuli O.;Fezza F.;Malvezzi E.;Vacca P.;Virga V.;Bezante G. P.;la Malfa G.;Bellotti M.;Cenni E.;Giuntini P.;Magnani O.;Sukkar S.;Gradaschi R.;Pisciotta L.;Esposito P.;Passalacqua G.;Bagnasco D.;Braido F.;Riccio A.;Tagliabue E.;Gustavino C.;Rosso N.;Papalia R.;Orengo G.;
2021-01-01
Abstract
BACKGROUND Increases in cardiac troponin (cTn) in coronavirus disease 2019 (COVID-19) have been associated with worse prognosis. Nonetheless, data about the significance of cTn in elderly subjects with COVID-19 are lacking. METHODS From a registry of consecutive patients with COVID-19 admitted to a hub hospital in Italy from 25/02/2020 to 03/07/2020, we selected those ≥ 60 year-old and with cTnI measured within three days from the molecular diagnosis of SARSCoV-2 infection. When available, a second cTnI value within 48 h was also extracted. The relationship between increased cTnI and all-cause in-hospital mortality was evaluated by a Cox regression model and restricted cubic spline functions with three knots. RESULTS Of 343 included patients (median age: 75.0 (68.0−83.0) years, 34.7% men), 88 (25.7%) had cTnI above the upper-reference limit (0.046 μg/L). Patients with increased cTnI had more comorbidities, greater impaired respiratory exchange and higher inflammatory markers on admission than those with normal cTnI. Furthermore, they died more (73.9% vs. 37.3%, P < 0.001) over 15 (6−25) days of hospitalization. The association of elevated cTnI with mortality was confirmed by the adjusted Cox regression model (HR = 1.61, 95%CI: 1.06−2.52, P = 0.039) and was linear until 0.3 μg/L, with a subsequent plateau. Of 191 (55.7%) patients with a second cTnI measurement, 49 (25.7%) had an increasing trend, which was not associated with mortality (univariate HR = 1.39, 95%CI: 0.87−2.22, P = 0.265). CONCLUSIONS In elderly COVID-19 patients, an initial increase in cTn is common and predicts a higher risk of death. Serial cTn testing may not confer additional prognostic information.
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