The prognostic value of serial troponin measurements in patients admitted for COVID-19

Vincenzo Nuzzi; Marco Merlo; Claudia Specchia; Carlo Mario Lombardi; Valentina Carubelli; Annamaria Iorio; Riccardo Maria Inciardi; Antonio Bellasi; Claudia Canale; Rita Camporotondo; Francesco Catagnano; Laura Adelaide Dalla Vecchia; Stefano Giovinazzo; Gloria Maccagni; Massimo Mapelli; Davide Margonato; Luca Monzo; Chiara Oriecuia; Giulia Peveri; Andrea Pozzi; Giovanni Provenzale; Filippo Sarullo; Daniela Tomasoni; Pietro Ameri; Massimiliano Gnecchi; Sergio Leonardi; Piergiuseppe Agostoni; Stefano Carugo; Gian Battista Danzi; Marco Guazzi; Maria Teresa La Rovere; Andrea Mortara; Massimo Piepoli; Italo Porto; Maurizio Volterrani; Michele Senni; Marco Metra; Gianfranco Sinagra

doi:10.1002/ehf2.13462

The prognostic value of serial troponin measurements in patients admitted for COVID-19

Vincenzo Nuzzi, Marco Merlo, Claudia Specchia, Carlo Mario Lombardi, Valentina Carubelli, Annamaria Iorio, Riccardo Maria Inciardi, Antonio Bellasi, Claudia Canale, Rita Camporotondo, Francesco Catagnano, Laura Adelaide Dalla Vecchia, Stefano Giovinazzo, Gloria Maccagni, Massimo Mapelli, Davide Margonato, Luca Monzo, Chiara Oriecuia, Giulia Peveri, Andrea PozziGiovanni Provenzale, Filippo Sarullo, Daniela Tomasoni, Pietro Ameri, Massimiliano Gnecchi, Sergio Leonardi, Piergiuseppe Agostoni, Stefano Carugo, Gian Battista Danzi, Marco Guazzi, Maria Teresa La Rovere, Andrea Mortara, Massimo Piepoli, Italo Porto, Maurizio Volterrani, Michele Senni, Marco Metra, Gianfranco Sinagra

Istituto San Raffaele Pisana

Research output: Contribution to journal › Article › peer-review

Abstract

AIMS: Myocardial injury (MI) in coronavirus disease-19 (COVID-19) is quite prevalent at admission and affects prognosis. Little is known about troponin trajectories and their prognostic role. We aimed to describe the early in-hospital evolution of MI and its prognostic impact.

METHODS AND RESULTS: We performed an analysis from an Italian multicentre study enrolling COVID-19 patients, hospitalized from 1 March to 9 April 2020. MI was defined as increased troponin level. The first troponin was tested within 24 h from admission, the second one between 24 and 48 h. Elevated troponin was defined as values above the 99th percentile of normal values. Patients were divided in four groups: normal, normal then elevated, elevated then normal, and elevated. The outcome was in-hospital death. The study population included 197 patients; 41% had normal troponin at both evaluations, 44% had elevated troponin at both assessments, 8% had normal then elevated troponin, and 7% had elevated then normal troponin. During hospitalization, 49 (25%) patients died. Patients with incident MI, with persistent MI, and with MI only at admission had a higher risk of death compared with those with normal troponin at both evaluations (P < 0.001). At multivariable analysis, patients with normal troponin at admission and MI injury on Day 2 had the highest mortality risk (hazard ratio 3.78, 95% confidence interval 1.10-13.09, P = 0.035).

CONCLUSIONS: In patients admitted for COVID-19, re-test MI on Day 2 provides a prognostic value. A non-negligible proportion of patients with incident MI on Day 2 is identified at high risk of death only by the second measurement.

Original language	English
Pages (from-to)	3504-3511
Number of pages	8
Journal	ESC heart failure
Volume	8
Issue number	5
DOIs	https://doi.org/10.1002/ehf2.13462
Publication status	Published - Oct 2021

Keywords

COVID-19/diagnosis
Hospital Mortality
Hospitalization
Humans
Italy
Prognosis
Troponin/blood

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10.1002/ehf2.13462

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Nuzzi, V., Merlo, M., Specchia, C., Lombardi, C. M., Carubelli, V., Iorio, A., Inciardi, R. M., Bellasi, A., Canale, C., Camporotondo, R., Catagnano, F., Dalla Vecchia, L. A., Giovinazzo, S., Maccagni, G., Mapelli, M., Margonato, D., Monzo, L., Oriecuia, C., Peveri, G., ... Sinagra, G. (2021). The prognostic value of serial troponin measurements in patients admitted for COVID-19. ESC heart failure, 8(5), 3504-3511. https://doi.org/10.1002/ehf2.13462

Nuzzi, V, Merlo, M, Specchia, C, Lombardi, CM, Carubelli, V, Iorio, A, Inciardi, RM, Bellasi, A, Canale, C, Camporotondo, R, Catagnano, F, Dalla Vecchia, LA, Giovinazzo, S, Maccagni, G, Mapelli, M, Margonato, D, Monzo, L, Oriecuia, C, Peveri, G, Pozzi, A, Provenzale, G, Sarullo, F, Tomasoni, D, Ameri, P, Gnecchi, M, Leonardi, S, Agostoni, P, Carugo, S, Danzi, GB, Guazzi, M, La Rovere, MT, Mortara, A, Piepoli, M, Porto, I, Volterrani, M, Senni, M, Metra, M & Sinagra, G 2021, 'The prognostic value of serial troponin measurements in patients admitted for COVID-19', ESC heart failure, vol. 8, no. 5, pp. 3504-3511. https://doi.org/10.1002/ehf2.13462

@article{fd100764e71f4c25ba5e55e91cf8ebd3,

title = "The prognostic value of serial troponin measurements in patients admitted for COVID-19",

abstract = "AIMS: Myocardial injury (MI) in coronavirus disease-19 (COVID-19) is quite prevalent at admission and affects prognosis. Little is known about troponin trajectories and their prognostic role. We aimed to describe the early in-hospital evolution of MI and its prognostic impact.METHODS AND RESULTS: We performed an analysis from an Italian multicentre study enrolling COVID-19 patients, hospitalized from 1 March to 9 April 2020. MI was defined as increased troponin level. The first troponin was tested within 24 h from admission, the second one between 24 and 48 h. Elevated troponin was defined as values above the 99th percentile of normal values. Patients were divided in four groups: normal, normal then elevated, elevated then normal, and elevated. The outcome was in-hospital death. The study population included 197 patients; 41% had normal troponin at both evaluations, 44% had elevated troponin at both assessments, 8% had normal then elevated troponin, and 7% had elevated then normal troponin. During hospitalization, 49 (25%) patients died. Patients with incident MI, with persistent MI, and with MI only at admission had a higher risk of death compared with those with normal troponin at both evaluations (P < 0.001). At multivariable analysis, patients with normal troponin at admission and MI injury on Day 2 had the highest mortality risk (hazard ratio 3.78, 95% confidence interval 1.10-13.09, P = 0.035).CONCLUSIONS: In patients admitted for COVID-19, re-test MI on Day 2 provides a prognostic value. A non-negligible proportion of patients with incident MI on Day 2 is identified at high risk of death only by the second measurement.",

keywords = "COVID-19/diagnosis, Hospital Mortality, Hospitalization, Humans, Italy, Prognosis, Troponin/blood",

author = "Vincenzo Nuzzi and Marco Merlo and Claudia Specchia and Lombardi, {Carlo Mario} and Valentina Carubelli and Annamaria Iorio and Inciardi, {Riccardo Maria} and Antonio Bellasi and Claudia Canale and Rita Camporotondo and Francesco Catagnano and {Dalla Vecchia}, {Laura Adelaide} and Stefano Giovinazzo and Gloria Maccagni and Massimo Mapelli and Davide Margonato and Luca Monzo and Chiara Oriecuia and Giulia Peveri and Andrea Pozzi and Giovanni Provenzale and Filippo Sarullo and Daniela Tomasoni and Pietro Ameri and Massimiliano Gnecchi and Sergio Leonardi and Piergiuseppe Agostoni and Stefano Carugo and Danzi, {Gian Battista} and Marco Guazzi and {La Rovere}, {Maria Teresa} and Andrea Mortara and Massimo Piepoli and Italo Porto and Maurizio Volterrani and Michele Senni and Marco Metra and Gianfranco Sinagra",

note = "{\textcopyright} 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.",

year = "2021",

month = oct,

doi = "10.1002/ehf2.13462",

language = "English",

volume = "8",

pages = "3504--3511",

journal = "ESC heart failure",

issn = "2055-5822",

publisher = "Wiley Blackwell",

number = "5",

}

TY - JOUR

T1 - The prognostic value of serial troponin measurements in patients admitted for COVID-19

AU - Nuzzi, Vincenzo

AU - Merlo, Marco

AU - Specchia, Claudia

AU - Lombardi, Carlo Mario

AU - Carubelli, Valentina

AU - Iorio, Annamaria

AU - Inciardi, Riccardo Maria

AU - Bellasi, Antonio

AU - Canale, Claudia

AU - Camporotondo, Rita

AU - Catagnano, Francesco

AU - Dalla Vecchia, Laura Adelaide

AU - Giovinazzo, Stefano

AU - Maccagni, Gloria

AU - Mapelli, Massimo

AU - Margonato, Davide

AU - Monzo, Luca

AU - Oriecuia, Chiara

AU - Peveri, Giulia

AU - Pozzi, Andrea

AU - Provenzale, Giovanni

AU - Sarullo, Filippo

AU - Tomasoni, Daniela

AU - Ameri, Pietro

AU - Gnecchi, Massimiliano

AU - Leonardi, Sergio

AU - Agostoni, Piergiuseppe

AU - Carugo, Stefano

AU - Danzi, Gian Battista

AU - Guazzi, Marco

AU - La Rovere, Maria Teresa

AU - Mortara, Andrea

AU - Piepoli, Massimo

AU - Porto, Italo

AU - Volterrani, Maurizio

AU - Senni, Michele

AU - Metra, Marco

AU - Sinagra, Gianfranco

PY - 2021/10

Y1 - 2021/10

N2 - AIMS: Myocardial injury (MI) in coronavirus disease-19 (COVID-19) is quite prevalent at admission and affects prognosis. Little is known about troponin trajectories and their prognostic role. We aimed to describe the early in-hospital evolution of MI and its prognostic impact.METHODS AND RESULTS: We performed an analysis from an Italian multicentre study enrolling COVID-19 patients, hospitalized from 1 March to 9 April 2020. MI was defined as increased troponin level. The first troponin was tested within 24 h from admission, the second one between 24 and 48 h. Elevated troponin was defined as values above the 99th percentile of normal values. Patients were divided in four groups: normal, normal then elevated, elevated then normal, and elevated. The outcome was in-hospital death. The study population included 197 patients; 41% had normal troponin at both evaluations, 44% had elevated troponin at both assessments, 8% had normal then elevated troponin, and 7% had elevated then normal troponin. During hospitalization, 49 (25%) patients died. Patients with incident MI, with persistent MI, and with MI only at admission had a higher risk of death compared with those with normal troponin at both evaluations (P < 0.001). At multivariable analysis, patients with normal troponin at admission and MI injury on Day 2 had the highest mortality risk (hazard ratio 3.78, 95% confidence interval 1.10-13.09, P = 0.035).CONCLUSIONS: In patients admitted for COVID-19, re-test MI on Day 2 provides a prognostic value. A non-negligible proportion of patients with incident MI on Day 2 is identified at high risk of death only by the second measurement.

AB - AIMS: Myocardial injury (MI) in coronavirus disease-19 (COVID-19) is quite prevalent at admission and affects prognosis. Little is known about troponin trajectories and their prognostic role. We aimed to describe the early in-hospital evolution of MI and its prognostic impact.METHODS AND RESULTS: We performed an analysis from an Italian multicentre study enrolling COVID-19 patients, hospitalized from 1 March to 9 April 2020. MI was defined as increased troponin level. The first troponin was tested within 24 h from admission, the second one between 24 and 48 h. Elevated troponin was defined as values above the 99th percentile of normal values. Patients were divided in four groups: normal, normal then elevated, elevated then normal, and elevated. The outcome was in-hospital death. The study population included 197 patients; 41% had normal troponin at both evaluations, 44% had elevated troponin at both assessments, 8% had normal then elevated troponin, and 7% had elevated then normal troponin. During hospitalization, 49 (25%) patients died. Patients with incident MI, with persistent MI, and with MI only at admission had a higher risk of death compared with those with normal troponin at both evaluations (P < 0.001). At multivariable analysis, patients with normal troponin at admission and MI injury on Day 2 had the highest mortality risk (hazard ratio 3.78, 95% confidence interval 1.10-13.09, P = 0.035).CONCLUSIONS: In patients admitted for COVID-19, re-test MI on Day 2 provides a prognostic value. A non-negligible proportion of patients with incident MI on Day 2 is identified at high risk of death only by the second measurement.

KW - COVID-19/diagnosis

KW - Hospital Mortality

KW - Hospitalization

KW - Humans

KW - Italy

KW - Prognosis

KW - Troponin/blood

U2 - 10.1002/ehf2.13462

DO - 10.1002/ehf2.13462

M3 - Article

C2 - 34236135

SN - 2055-5822

VL - 8

SP - 3504

EP - 3511

JO - ESC heart failure

JF - ESC heart failure

IS - 5

ER -

The prognostic value of serial troponin measurements in patients admitted for COVID-19

Abstract

Keywords

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