Theranostics 2020; 10(21):9663-9673. doi:10.7150/thno.47980

Research Paper

Myocardial injury and COVID-19: Serum hs-cTnI level in risk stratification and the prediction of 30-day fatality in COVID-19 patients with no prior cardiovascular disease

Jiatian Cao1#, Yan Zheng1,2,3#, Zhe Luo4#, Zhendong Mei2#, Yumeng Yao5, Zilong Liu6, Chao Liang7, Hongbo Yang1, Yanan Song1, Kaihuan Yu8, Yan Gao9, Chouwen Zhu10, Zheyong Huang1✉, Juying Qian1✉, Junbo Ge1✉

1. Department of Cardiology, Zhongshan Hospital, Fudan University. Shanghai Institute of Cardiovascular Diseases. 180 Feng Lin Road, Shanghai 200032, China.
2. State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai 200438, China.
3. Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Shanghai, 200438 China.
4. Department of Critical Medicine, Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai 200032, China.
5. Department of Infectious Diseases, Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai 200032, China.
6. Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai 200032, China.
7. Department of Anesthesiology, Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai 200032, China.
8. Department of Hepatobiliary Surgery, Renmin Hospital of Wuhan University. Gaoxin 6th Road, Donghu high tech Development Zone, Wuhan 430200, China.
9. Department of Neurology, Remin Hospital of Wuhan University, 99 Ziyang Road,Wuchang District, Wuhan 430200, China.
10. Department of Gastroenterology, Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai 200032, China.
#These authors contributed equally to this work.

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Citation:
Cao J, Zheng Y, Luo Z, Mei Z, Yao Y, Liu Z, Liang C, Yang H, Song Y, Yu K, Gao Y, Zhu C, Huang Z, Qian J, Ge J. Myocardial injury and COVID-19: Serum hs-cTnI level in risk stratification and the prediction of 30-day fatality in COVID-19 patients with no prior cardiovascular disease. Theranostics 2020; 10(21):9663-9673. doi:10.7150/thno.47980. Available from https://www.thno.org/v10p9663.htm

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Abstract

Introduction: To explore the involvement of the cardiovascular system in coronavirus disease 2019 (COVID-19), we investigated whether myocardial injury occurred in COVID-19 patients and assessed the performance of serum high-sensitivity cardiac Troponin I (hs-cTnI) levels in predicting disease severity and 30-day in-hospital fatality.

Methods: We included 244 COVID-19 patients, who were admitted to Renmin Hospital of Wuhan University with no preexisting cardiovascular disease or renal dysfunction. We analyzed the data including patients' clinical characteristics, cardiac biomarkers, severity of medical conditions, and 30-day in-hospital fatality. We performed multivariable Cox regressions and the receiver operating characteristic analysis to assess the association of cardiac biomarkers on admission with disease severity and prognosis.

Results: In this retrospective observational study, 11% of COVID-19 patients had increased hs-cTnI levels (>40 ng/L) on admission. Of note, serum hs-cTnI levels were positively associated with the severity of medical conditions (median [interquartile range (IQR)]: 6.00 [6.00-6.00] ng/L in 91 patients with moderate conditions, 6.00 [6.00-18.00] ng/L in 107 patients with severe conditions, and 11.00 [6.00-56.75] ng/L in 46 patients with critical conditions, P for trend=0.001). Moreover, compared with those with normal cTnI levels, patients with increased hs-cTnI levels had higher in-hospital fatality (adjusted hazard ratio [95% CI]: 4.79 [1.46-15.69]). The receiver-operating characteristic curve analysis suggested that the inclusion of hs-cTnI levels into a panel of empirical prognostic factors substantially improved the prediction performance for severe or critical conditions (area under the curve (AUC): 0.71 (95% CI: 0.65-0.78) vs. 0.65 (0.58-0.72), P=0.01), as well as for 30-day fatality (AUC: 0.91 (0.85-0.96) vs. 0.77 (0.62-0.91), P=0.04). A cutoff value of 20 ng/L of hs-cTnI level led to the best prediction to 30-day fatality.

Conclusions: In COVID-19 patients with no preexisting cardiovascular disease, 11% had increased hs-cTnI levels. Besides empirical prognostic factors, serum hs-cTnI levels upon admission provided independent prediction to both the severity of the medical condition and 30-day in-hospital fatality. These findings may shed important light on the clinical management of COVID-19.

Keywords: Troponin I, COVID-19, myocardial injury, in-hospital fatality