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
Article Information
Identifiers and Pagination:
Year: 2022Volume: 16
E-location ID: e187419242207210
Publisher ID: e187419242207210
DOI: 10.2174/18741924-v16-e2207210
Article History:
Received Date: 18/1/2022Revision Received Date: 30/03/2022
Acceptance Date: 5/5/2022
Electronic publication date: 26/09/2022
Collection year: 2022
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.
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.
