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García de Guadiana-Romualdo L, Morell-García D, Rodríguez-Fraga O, Morales-Indiano C, María Lourdes Padilla Jiménez A, Gutiérrez Revilla JI, Urrechaga E, Álamo JM, Hernando Holgado AM, Lorenzo-Lozano MDC, Sánchez Fdez-Pacheco S, de la Hera Cagigal P, Juncos Tobarra MÁ, Vílchez JA, Vírseda Chamorro I, Gutiérrez Garcia I, Pastor Murcia Y, Sahuquillo Frías L, Altimira Queral L, Nuez-Zaragoza E, Adell Ruiz de León J, Ruiz Ripa A, Salas Gómez-Pablos P, Cebreiros López I, Fernández Uriarte A, Larruzea Á, López Yepes ML, Sancho-Rodríguez N, Zamorano Andrés MC, Pedregosa Díaz J, Acevedo Alcaraz C, Blázquez Manzanera AL, Pérez Sanmartín S, Baamonde Calzada MDC, Vera M, Valera Nuñez E, Canalda Campás M, García Muñoz S, Bauça JM, Vicente Gutiérrez L, Jiménez Añón L, Pérez Martínez A, Pons Castillo A, González Tamayo R, Férriz Vivancos J, José Alcaide Martín M, Ferrer Díaz de Brito Fernández V, Aguadero V, García Arévalo MG, Arnaldos Carrillo M, González Morales M, Núñez Gárate M, Ruiz Iruela C, Esteban Torrella P, Vila Pérez M, Egea-Caparrós JM, Sáenz L, Galán Ortega A, Consuegra-Sánchez L. Cardiac troponin and COVID-19 severity: Results from BIOCOVID study. Eur J Clin Invest 2021; 51:e13532. [PMID: 33660278 PMCID: PMC7995181 DOI: 10.1111/eci.13532] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/24/2021] [Accepted: 02/27/2021] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
| | - Daniel Morell-García
- Laboratory Medicine Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - Cristian Morales-Indiano
- Laboratory Medicine Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | | | | | - José María Álamo
- Biochemical Laboratory, Hospital Marina Baixa, Villajoyosa, Spain
| | | | | | | | | | | | - Juan A Vílchez
- Laboratory Medicine Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | | | | | - Yolanda Pastor Murcia
- Laboratory Medicine Department, Consorci Hospital General Universitari de València, Valencia, Spain
| | | | - Laura Altimira Queral
- Laboratory Medicine Department, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Elisa Nuez-Zaragoza
- Laboratory Medicine Department, Consorci Corporació Sanitària Parc Tauli, Sabadell, Barcelona, Spain
| | | | - Alicia Ruiz Ripa
- Laboratory Medicine Department, Hospital de Mataró, Mataró, Barcelona, Spain
| | | | - Iria Cebreiros López
- Laboratory Medicine Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | - Álex Larruzea
- Laboratory Medicine Department, Hospital Fundació Sanitària Mollet, Barcelona, Spain
| | | | | | | | | | - Cristina Acevedo Alcaraz
- Laboratory Medicine Department, Hospital Universitario Los Arcos del Mar Menor, San Javier, Spain
| | | | - Sonia Pérez Sanmartín
- Laboratory Medicine Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Marina Vera
- Biochemical Laboratory, Hospital Marina Baixa, Villajoyosa, Spain
| | - Elena Valera Nuñez
- Laboratory Medicine Department, Complejo Hospitalario de Toledo, Toledo, Spain
| | | | - Sara García Muñoz
- Laboratory Medicine Department, Hospital Universitario de Basurto, Bilbao, Spain
| | - Josep Miquel Bauça
- Laboratory Medicine Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Luis Vicente Gutiérrez
- Laboratory Medicine Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Laura Jiménez Añón
- Laboratory Medicine Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | | | - Ruth González Tamayo
- Laboratory Medicine Department, Hospital Universitario de Torrevieja, Torrevieja, Spain
| | - Jorge Férriz Vivancos
- Laboratory Medicine Department, Consorci Hospital General Universitari de València, Valencia, Spain
| | | | | | - Vicente Aguadero
- Laboratory Medicine Department, Consorci Corporació Sanitària Parc Tauli, Sabadell, Barcelona, Spain
| | | | | | | | | | - Cristina Ruiz Iruela
- Laboratory Medicine Department, Hospital Fundació Sanitària Mollet, Barcelona, Spain
| | | | - Martí Vila Pérez
- Laboratory Medicine Department, Hospital Verge de la Cinta, Tortosa, Spain
| | | | - Luis Sáenz
- Laboratory Medicine Department, Hospital General Universitario Rafael Méndez, Lorca, Spain
| | - Amparo Galán Ortega
- Comisión de Magnitudes Biológicas relacionadas con la Urgencia Médica, Sociedad Española de Medicina de Laboratorio (SEQC-ML), Barcelona, Spain
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