Cardiac troponin and COVID‐19 severity: Results from BIOCOVID study
Authors: García de Guadiana‐Romualdo Luis , Morell‐García Daniel , Rodríguez‐Fraga Olaia , Morales‐Indiano Cristian , María Lourdes Padilla Jiménez Ana , Gutiérrez Revilla José Ignacio , Urrechaga Eloísa , Álamo José María , Hernando Holgado Ana María , Lorenzo‐Lozano María del Carmen , Sánchez Fdez‐Pacheco Silvia , de la Hera Cagigal Patricia , Juncos Tobarra María Ángeles , Vílchez Juan A. , Vírseda Chamorro Isabel , Gutiérrez Garcia Irene , Pastor Murcia Yolanda , Sahuquillo Frías Laura , Altimira Queral Laura , Nuez‐Zaragoza Elisa , Adell Ruiz de León Juan , Ruiz Ripa Alicia , Salas Gómez‐Pablos Paloma , Cebreiros López Iria , Fernández Uriarte Amaia , Larruzea Álex , López Yepes María Luisa , Sancho‐Rodríguez Natalia , Zamorano Andrés María Consuelo , Pedregosa Díaz José , Acevedo Alcaraz Cristina , Blázquez Manzanera Alfonso‐L , Pérez Sanmartín Sonia , Baamonde Calzada María del Carmen , Vera Marina , Valera Nuñez Elena , Canalda Campás Magdalena , García Muñoz Sara , Bauça Josep Miquel , Vicente Gutiérrez Luis , Jiménez Añón Laura , Pérez Martínez Alfonso , Pons Castillo Aurelio , González Tamayo Ruth , Férriz Vivancos Jorge , José Alcaide Martín María , Ferrer Díaz de Brito Fernández Vicente , Aguadero Vicente , García Arévalo María Gloria , Arnaldos Carrillo María , González Morales Mercedes , Núñez Gárate María , Ruiz Iruela Cristina , Esteban Torrella Patricia , Vila Pérez Martí , Egea‐Caparrós Jose Manuel , Sáenz Luis , Galán Ortega Amparo , Consuegra‐Sánchez Luciano 
Published: March 2021

Background

Myocardial injury is a common finding in COVID‐19 strongly associated with severity. We analysed the prevalence and prognostic utility of myocardial injury, characterized by elevated cardiac troponin, in a large population of COVID‐19 patients, and further evaluated separately the role of troponin T and I.

Methods

This is a multicentre, retrospective observational study enrolling patients with laboratory‐confirmed COVID‐19 who were hospitalized in 32 Spanish hospitals. Elevated troponin levels were defined as values above the sex‐specific 99th percentile upper reference limit, as recommended by international guidelines. Thirty‐day mortality was defined as endpoint.

Results

A total of 1280 COVID‐19 patients were included in this study, of whom 187 (14.6%) died during the hospitalization. Using a nonspecific sex cut‐off, elevated troponin levels were found in 344 patients (26.9%), increasing to 384 (30.0%) when a sex‐specific cut‐off was used. This prevalence was significantly higher (42.9% vs 21.9%; P < .001) in patients in whom troponin T was measured in comparison with troponin I. Sex‐specific elevated troponin levels were significantly associated with 30‐day mortality, with adjusted odds ratios (ORs) of 3.00 for total population, 3.20 for cardiac troponin T and 3.69 for cardiac troponin I.

Conclusion

In this multicentre study, myocardial injury was a common finding in COVID‐19 patients. Its prevalence increased when a sex‐specific cut‐off and cardiac troponin T were used. Elevated troponin was an independent predictor of 30‐day mortality, irrespective of cardiac troponin assay and cut‐offs to detect myocardial injury. Hence, the early measurement of cardiac troponin may be useful for risk stratification in COVID‐19.