Am J Cardiol
Elevations in troponin levels have been shown to predict mortality in patients with coronavirus disease 2019 (COVID-19). The role of inflammation in myocardial injury remains unclear. We sought to determine the association of elevated troponin with mortality in a large, ethnically diverse population of patients hospitalized with COVID-19, and to determine the association of elevated inflammatory markers with increased troponin levels. We reviewed all patients admitted at our health system with COVID-19 from March 1 to April 27, 2020, who had a troponin assessment within 48 hours of admission. We used logistic regression to calculate odds ratios (ORs) for mortality during hospitalization, controlling for demographics, comorbidities, and markers of inflammation. Of 11159 patients hospitalized with COVID-19, 6247 had a troponin assessment within 48 hours. Of these, 4426 (71%) patients had normal, 919 (15%) had mildly elevated, and 902 (14%) had severely elevated troponin. Acute phase and inflammatory markers were significantly elevated in patients with mildly and severely elevated troponin compared to normal troponin. Patients with elevated troponin had significantly increased odds of death for mildly elevated compared to normal troponin (adjusted OR, 2.06; 95% CI, 1.68-2.53; P < .001) and for severely elevated compared to normal troponin (OR, 4.51; 95% CI, 3.66-5.54; P < .001) independently of elevation in inflammatory markers. In conclusion, patients hospitalized with COVID-19 and elevated troponin had markedly increased mortality compared to patients with normal troponin levels. This risk was independent of cardiovascular comorbidities and elevated markers of inflammation.
School of Medicine