Normal high-sensitivity cardiac troponin for ruling-out inpatient mortality in acute COVID-19

Authors: Liu, Alexander;

Hammond, Robert;

Chan, Kenneth;

Chukwuenweniwe, Chukwugozie;

Johnson, Rebecca;

Khair, Duaa;

Duck, Eleanor;

Olubodun, Oluwaseun;

Barwick, Kristian;

Banya, Winston;

Stirrup, James;

Donnelly, Peter D.;

Kaski, Juan Carlos;

Coates, Anthony R.M.

Source: PLoS ONE

Full text

: https://doi.org/10.1371/journal.pone.0284523

Abstract

Introduction Assessment of inpatient mortality risk in COVID-19 patients is important for guiding clinical decision-making. High sensitivity cardiac troponin T (hs-cTnT) is a biomarker of cardiac injury associated with a worse prognosis in COVID-19. We explored how hs-cTnT could potentially be used in clinical practice for ruling in and ruling out mortality in COVID-19. Method We tested the diagnostic value of hs-cTnT in laboratory-confirmed COVID-19 patients (≥18 years old) admitted to the Royal Berkshire Hospital (UK) between 1st March and 10th May 2020. A normal hs-cTnT was defined as a value within the 99th percentile of healthy individuals (≤14 ng/L), and an elevated hs-cTnT was defined as >14 ng/L. Adverse clinical outcome was defined as inpatient mortality related to COVID-19. Results A total of 191 COVID-19 patients (62% male; age 66±16 years) had hs-cTnT measured on admission. Of these patients, 124 (65%) had elevated hs-cTnT and 67 (35%) had normal hs-cTnT. On a group level, patients with elevated hs-cTnT had worse inpatient survival (p = 0.0014; Kaplan-Meier analysis) and higher risk of inpatient mortality (HR 5.84 [95% CI 1.29–26.4]; p = 0.02; Cox multivariate regression) compared to patients with normal hs-cTnT. On a per-patient level, a normal hs-cTnT had a negative predictive value of 94% (95% CI: 85–98%) for ruling out mortality, whilst an elevated hs-cTnT had a low positive predictive value of 38% (95% CI: 39–47%) for ruling in mortality. Conclusions In this study cohort of COVID-19 patients, the potential clinical utility of hs-cTnT appears to rest in ruling out inpatient mortality. This finding, if prospectively validated in a larger study, may allow hs-cTnT to become an important biomarker to facilitate admission-avoidance and early safe discharge.

Rights

Copyright: © 2023 Liu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. http://creativecommons.org/licenses/by/4.0/

Cite as

Liu, A., Hammond, R., Chan, K., Chukwuenweniwe, C., Johnson, R., Khair, D., Duck, E., Olubodun, O., Barwick, K., Banya, W., Stirrup, J., Donnelly, P., Kaski, J. & Coates, A. 2023, 'Normal high-sensitivity cardiac troponin for ruling-out inpatient mortality in acute COVID-19', PLoS ONE, 18(4), article no: e0284523. https://doi.org/10.1371/journal.pone.0284523

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DOI: https://doi.org/10.1371/journal.pone.0284523

Repository URI: http://hdl.handle.net/10023/27473