Troponin is a useful marker in clinical decision making in hospitalized patients with COVID-19 infections

Fahimeh Safarnezhad-Tameshkel; Nima Motamed; Mohammad Hadi Karbalaie Niya; Dhayaneethie Perumal; Nader Rezaie; Shirin Izadi; Mitra Ranjbar; Mahdi Yadollahzadeh; Behnam Behdad; Gholamreza Hemmasi; Vahid Kaveh; Ali Arash Anoushirvani; Mojtaba Malek; Behzad Farahani; Ramin Eskandari; Mahshid Panahi; Mandana Rahimi; Sepideh Emami; Farhad Zamani; Mohsen Farrokhpour

doi:10.22122/arya.v17i0.2191

Troponin is a useful marker in clinical decision making in hospitalized patients with COVID-19 infections

ARYA Atheroscler. 2021 Sep;17(5):1-7. doi: 10.22122/arya.v17i0.2191.

Authors

Fahimeh Safarnezhad-Tameshkel¹, Nima Motamed², Mohammad Hadi Karbalaie Niya³, Dhayaneethie Perumal⁴, Nader Rezaie⁵, Shirin Izadi⁶, Mitra Ranjbar⁷, Mahdi Yadollahzadeh⁸, Behnam Behdad⁹, Gholamreza Hemmasi¹⁰, Vahid Kaveh¹¹, Ali Arash Anoushirvani¹², Mojtaba Malek¹³, Behzad Farahani¹⁴, Ramin Eskandari¹⁴, Mahshid Panahi¹⁵, Mandana Rahimi¹⁵, Sepideh Emami¹⁴, Farhad Zamani¹⁶, Mohsen Farrokhpour⁸

Affiliations

¹ Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran.
² Associate Professor, Department of Social Medicine, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
³ Assistant Professor, Gastrointestinal and Liver Diseases Research Center AND Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
⁴ Assistant Professor, School of Science, Engineering and Computing, Kingston University, Kingston, United Kingdom.
⁵ Associate Professor, Department of Pulmonology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
⁶ Assistant Professor, Department of Pulmonology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
⁷ Professor, Department of Infectious Diseases, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
⁸ Assistant Professor, Department of Internal Medicine, School of Medicine, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
⁹ Resident, Department of Internal Medicine, School of Medicine, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
¹⁰ Associate Professor, Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran.
¹¹ Assistant Professor, Department of Hematology and Medical Oncology, School of Medicine, Iran University Medical Sciences, Tehran, Iran.
¹² Associate Professor, Department of Hematology and Medical Oncology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
¹³ Associate Professor, Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran.
¹⁴ Assistant Professor, Department of Cardiology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
¹⁵ Assistant Professor, Department of Pathology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
¹⁶ Professor, Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran.

Abstract

Background: COVID-19 was introduced by the World Health Organization (WHO) as a global pandemic. The disease manifestations ranges from a mild common cold to severe disease and death. It has a higher mortality rate in people with a history of comorbidities, including cardiovascular disease (CVD) and can also contribute to cardiac injury. This study was conducted to evaluate the relationship between troponin levels as a cardiac marker and adverse outcomes in this disease.

Methods: The study sample included 438 patients hospitalized with COVID-19; however, the troponin data of 6 patients were not available. The need to be admitted to the intensive care unit (ICU), and death were considered the adverse outcome in patients with COVID-19. Troponin levels were checked in all patients on day 1 and day 3 of hospitalization. Multiple logistic regression analysis was performed to determine whether there was an independent association between the adverse outcomes and troponin enzyme in hospitalized patients with COVID-19.

Results: The mean age of patients was 61.29 ± 15.84 years. Among the 432 patients tested on day 1 of hospitalization, 24 patients (5.6%) tested positive (Troponin 1), and among the 303 patients tested on day 3, 13 patients (4.3%) tested positive (Troponin 2). Based on our results, Troponin 1 showed an independent association with both death (3.008 [95%CI = 1.091-8.290]; P = 0.033) and need for ICU admission (8.499 [95%CI = 3.316-21.788]; P < 0.001) in multiple logistic regression analysis. Moreover, the status of Troponin 2 had an independent significant association with both death (4.159 [95%CI = 1.156-14.961]; P = 0.029) and ICU admission (7.796 [95%CI = 1.954-31.097]; P = 0.004).

Conclusion: Troponin showed a significant association with adverse outcomes in people who were hospitalized with COVID-19. The periodical assessment of this enzyme from the time of hospitalization may improve the clinical decision making of clinicians.

Keywords: COVID-19; Mortality; Troponin.