Abstract 15582: Hospitalized COVID-19 Patients With Elevated Cardiac Troponin I Have Increased Overall Mortality and Ventilation Requirements

Abstract

Introduction: Coronavirus disease 2019 (COVID-19) causes increased mortality and morbidity in patients with underlying cardiovascular disease. Elevated cardiac troponin I (cTnI) can suggest either a co-concurrent myocarditis or acute primary or secondary myocardial injury. Understanding how laboratory values predict disease severity is important for clinicians to guide therapy and triage patients. Hypothesis: cTnI may help identify the subsets of COVID-19 patients that progress to worse clinical outcomes. Methods: A cross sectional study was performed utilizing the 184 hospital United States database of HCA. Patients were selected based on inpatient visits to HCA facilities from February 2020 to May 2020 with a COVID-19 diagnosis and at least one cTnI lab test. Patients were divided according to an elevated or normal cTnI value based on the 99th percentile reference range of the test. Outcomes, such as mortality and need for mechanical ventilation, were compared. Results: 3968 patients hospitalized with COVID-19 were identified. Of those, 3158 patients had at least one cTnI test during their hospitalization. 829 (26%) had at least one positive cTnI during their hospitalization. 328 patients with at least one positive cTnI during their hospitalization died and 174 patients without a positive cTnI died (OR: 14.4 CI: 11.39 -18.30 p<0.0001). 333 patients with positive cTnI required mechanical ventilation, but only 314 with negative cTnI required mechanical ventilation (p<0.001). Conclusions: Patients with at least one positive cTnI during their hospitalization had increased mortality. Using a large nationwide database we confirmed previously published findings in smaller patient populations associating cardiovascular disease with COVID-19 severity. Patients with elevated cTnI were also more likely to require mechanical ventilation, suggesting the COVID-19 acute respiratory distress syndrome has a more complicated relationship to troponin levels. These findings suggest that patients with an increased cTnI should be triaged to receive aggressive management. Future steps would be to evaluate effects of aging and other risk factors on the outcome.