COVID-19 patients with elevated troponin levels face a greater risk of death

Elevated troponin levels can help clinicians identify COVID-19 patients at a higher risk of death or ICU admission, according to a new study published in the American Journal of Cardiology.  

The authors evaluated data from more than 6,000 consecutive COVID-19 patients admitted to one of 13 hospitals in a New York City-based health system. Patients were excluded due to chronic kidney disease and end-stage renal disease.

All patients received treatment from March 1 to April 27, 2020. Troponin assessments occurred within 48 hours of being admitted. While 63% of patients had a history of hypertension, coronary artery disease, peripheral vascular disease or heart failure, 17% had a history of two of those conditions. Three percent of patients, meanwhile, had a history of at least three of those conditions.

Overall, 71% of patients had normal troponin levels, 15% had mild elevation and another 14% had severe elevation. Patients with elevated troponin levels—mild or severe—had a significantly increased risk of death, and ICU admission was much more common when the patient had elevated troponin levels.

In addition, the team noted, patients with mildly elevated troponin levels longer lengths of stay—but not patients with severely elevated levels.

“Patients admitted with COVID-19 should have an assessment of troponin to assist in risk stratification and to identify patients who may need further evaluation and escalation of care,” wrote lead author David T. Majure, MD, North Shore University Hospital in Manhasset, New York, and colleagues. “Further research is needed to fully understand the mechanisms of myocardial injury in patients with COVID-19.”

The full study is available here.