ELEVATED TROPONIN I TREND IS ASSOCIATED WITH POOR PROGNOSIS IN CRITICAL COVID-19 PATIENTS

Derya Gokcinar^{1, *} Ayse Lafci¹, Osman Dag², Isil Ozkocak Turan¹, Huseyın Levent Yamanel³ 

¹Department of Anesthesiology and Reanimation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey - ²Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey - ³Department of Internal Medicine and Intensive Care, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey

Introduction: Cardiac etiology may play a role in deaths due to the Coronavirus disease 2019 (COVID-19). Therefore, the relationship between troponin I and mortality in critical COVID-19 patients is of interest. Troponin I, one of the heart-specific proteins, is used as a biomarker to detect myocardial necrosis. In the present study, our aim is to demonstrate the relationship of the Troponin I trend with mortality in critical COVID-19 patients.

Materials and methods: A retrospective analysis was carried out for critical COVID-19 patients who were admitted to the intensive care unit at Ankara City Hospital, a tertiary center, during the early period of the pandemic between March 18, 2020 and April 28, 2020. The patients, whose Troponin I were measured regularly and for the longest period, were selected in order to draw the trends. These patients were distributed into two groups as survivor and death groups according to mortality in the intensive care unit.

Results: It was found that 18 of the 66 critical COVID-19 patients, the troponin I concentration was measured regularly every day for a period of minimum 13 days. The mean age ± SEM (Standard error of mean) was 68.25±4.28 years in the survivor group and 70.83±2.58 years in the death group (P>0.05). The mean APACHE II ± SEM was 16.08±2.95 in the survivor group and 36.17±5.67 in the death group (P<0.05). The mean troponin I concentration ± SEM on day 13 was 63.26±39.90 ng/L in the death group, while the mean troponin I ± SEM was 12.01±5.03 ng/L (P<0.05) in the survivor group. 

Conclusion: The elevation in the troponin I trend in patients with COVID-19 was associated with mortality.   In critically ill patients who survived, the mean troponin I approximately 5 times lower on day 13 compared to the patients who did not survive. Despite all vital supportive treatments, some of the patients with COVID-19 rapidly progressed to death. Monitoring the changes in troponin I trend can indicate the severity and prognosis of the disease.