Admission High-Sensitive Cardiac Troponin T Level Increase Is Independently Associated with Higher Mortality in Critically Ill Patients with COVID-19: A Multicenter Study

Romaric Larcher; Noemie Besnard; Aziz Akouz; Emmanuelle Rabier; Lauranne Teule; Thomas Vandercamere; Samuel Zozor; Matthieu Amalric; Racim Benomar; Vincent Brunot; Philippe Corne; Olivier Barbot; Anne-Marie Dupuy; Jean-Paul Cristol; Kada Klouche

doi:10.3390/jcm10081656

Admission High-Sensitive Cardiac Troponin T Level Increase Is Independently Associated with Higher Mortality in Critically Ill Patients with COVID-19: A Multicenter Study

J Clin Med. 2021 Apr 13;10(8):1656. doi: 10.3390/jcm10081656.

Authors

Romaric Larcher^{1

2}, Noemie Besnard³, Aziz Akouz⁴, Emmanuelle Rabier⁵, Lauranne Teule⁴, Thomas Vandercamere⁵, Samuel Zozor¹, Matthieu Amalric³, Racim Benomar³, Vincent Brunot³, Philippe Corne³, Olivier Barbot⁴, Anne-Marie Dupuy¹, Jean-Paul Cristol^{1

2}, Kada Klouche^{2

3}

Affiliations

¹ Biochemistry and Hormonology Department, Lapeyronie Hospital, University Hospital of Montpellier, 34090 Montpellier, France.
² PhyMedExp, University of Montpellier, INSERM, CNRS, Arnaud de Villeneuve Hospital, University Hospital of Montpellier, 34090 Montpellier, France.
³ Intensive Care Medicine Department, Lapeyronie Hospital, University Hospital of Montpellier, 34090 Montpellier, France.
⁴ Intensive Care Unit, Hospital of Perpignan, 66000 Perpignan, France.
⁵ Intensive Care Unit, Hospital of Narbonne, 11100 Narbonne, France.

Abstract

Background: In coronavirus disease 2019 (COVID-19) patients, increases in high-sensitive cardiac troponin T (hs-cTnT) have been reported to be associated with worse outcomes. In the critically ill, the prognostic value of hs-cTnT, however, remains to be assessed given that most previous studies have involved a case mix of non- and severely ill COVID-19 patients.

Methods: We conducted, from March to May 2020, in three French intensive care units (ICUs), a multicenter retrospective cohort study to assess in-hospital mortality predictability of hs-cTnT levels in COVID-19 patients.

Results: 111 laboratory-confirmed COVID-19 patients (68% of male, median age 67 (58-75) years old) were included. At ICU admission, the median Charlson Index, Simplified Acute Physiology Score II, and PaO₂/FiO₂ were at 3 (2-5), 37 (27-48), and 140 (98-154), respectively, and the median hs-cTnT serum levels were at 16.0 (10.1-31.9) ng/L. Seventy-five patients (68%) were mechanically ventilated, 41 (37%) were treated with norepinephrine, and 17 (15%) underwent renal replacement therapy. In-hospital mortality was 29% (32/111) and was independently associated with lower PaO₂/FiO₂ and higher hs-cTnT serum levels.

Conclusions: At ICU admission, besides PaO₂/FiO₂, hs-cTnT levels may allow early risk stratification and triage in critically ill COVID-19 patients.

Keywords: COVID-19; ICU; SARS-CoV-2; high-sensitive cardiac troponin T; myocardial injury; outcomes.