PLoS ONE (Jan 2023)

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

  • Alexander Liu,
  • Robert Hammond,
  • Kenneth Chan,
  • Chukwugozie Chukwuenweniwe,
  • Rebecca Johnson,
  • Duaa Khair,
  • Eleanor Duck,
  • Oluwaseun Olubodun,
  • Kristian Barwick,
  • Winston Banya,
  • James Stirrup,
  • Peter D Donnelly,
  • Juan Carlos Kaski,
  • Anthony R M Coates

DOI
https://doi.org/10.1371/journal.pone.0284523
Journal volume & issue
Vol. 18, no. 4
p. e0284523

Abstract

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IntroductionAssessment 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.MethodWe 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.ResultsA 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.ConclusionsIn 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.