High-sensitivity troponin I levels and their ability to predict unfavorable outcomes in hospitalized patients with SARS-CoV-2 infection

Introduction: There are large knowledge gaps regarding the usefulness of high-sensitivity troponin I (TnI) as a predictor of worse outcomes in SARS-CoV-2 disease, including complications and death. Objective: To determine the degree of association between TnI levels at admission and in-hospital mortality from SARS-CoV-2. Materials and method: Cohort study on patients hospitalized for SARS-CoV-2, with measurement of TnI at the time of admission. The association between positive TnI and in-hospital mortality was evaluated, controlled for clinical factors, comorbidities and other predictive serum markers of severity. Additionally, the analysis of the area under the curve (AUC) was performed to evaluate the discrimination capacity of TnI to identify patients with in-hospital mortality. Results: 240 patients (19.6% with positive TnI) were included. The hospital mortality rate was 14.0 vs. 40.4%, p < 0.001, and the admission rate to the intensive care unit was 32.1 vs. 74.4%, p < 0.001, it was higher in patients with positive TnI. Multivariate analysis highlighted that positive TnI was independently associated with hospital mortality (OR: 3.68; 95% CI: 1.35-10.08; p = 0.011) after controlling for the other prognostic factors. An acceptable ability of discrimination to predict in-hospital mortality was evidenced (AUC: 0.70; 95% CI: 0.62-0.78). Conclusions: TnI measured at hospital admission, as a marker of myocardial injury, is an independent risk predictor of in-hospital mortality. Intensive monitoring and treatment should be considered in TnI-positive patients.