RESEARCH ARTICLE


Elevated Troponin and Mortality in Patients with COVID-19: A Multicenter Retrospective Cohort Study



Chukwuemeka A. Umeh1, *, Sobiga Ranchithan1, 2, Kimberly Watanabe1, 3, Laura Tuscher1, 3, Rahul Gupta1
1 Department of Internal Medicine, Hemet Global Medical Center, Hemet, California, USA
2 Department of Internal Medicine, American University of Antigua, Osbourn, Antigua and Barbuda
3 St. George's University, School of Medicine, True Blue, West Indies, Grenada


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Creative Commons License
© 2022 Umeh et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Internal Medicine, Hemet Global Medical Center, 1117 E. Devonshire Ave. Hemet, California, USA; Tel: +19516522811; E-mail: emmyumeh@yahoo.com


Abstract

Introduction:

Myocardial injury, causing elevated troponin levels, have been associated with worse outcomes in coronavirus disease 2019 (COVID-19) disease patients. However, our anecdotal experience did not consistently reflect this pattern. Therefore, we evaluated the outcomes of COVID-19 patients with elevated troponin.

Methods:

This is a retrospective study of 1,024 COVID-19 patients admitted to two hospitals in Southern California in the United States. We categorized the troponin levels as normal (≤1× upper reference limit (URL)), mildly elevated (>1 to ≤3× URL), and severely elevated (>3× URL). We compared the characteristics of the three troponin groups using chi-square for categorical variables and one-way Anova for the continuous variables. Finally, backward selection Cox regression analysis was carried out using mortality as a dependent variable.

Results:

Of the COVID-19 1,024 patients included in the study, 944 (92%) had normal troponin, 45 (4.4%) had mild elevation, and 35 (3.4%) had a severe elevation in troponin levels. In the multivariate Cox regression analysis, troponin elevation in patients without ST-elevation on ECG was not independently associated with mortality (hazard ratio 0.92, 95% CI 0.64-1.3). Increased risk of death was independently associated with age as well as serum C-reactive protein and serum creatinine levels.

Conclusion:

Elevated troponins without ST-elevation on ECG on hospital admission were not independently associated with increased mortality in hospitalized COVID-19 patients. However, further research is needed to fully understand the absence of a relationship between troponin elevation and mortality in our study population.

Keywords: COVID-19, SARS-CoV-2, Troponin, Myocarditis, Mortality, ICU admission, Mechanical ventilation, Length of stay.