Clinical Uncertainties Of Cardiac Troponin İnterpretation Among COVID-19

Muhammed Emin Düz¹, Aydın Balcı², Elif Menekşe^1, Alpaslan Öztürk¹

¹Amasya University, Sabuncuoğlu Şerefeddin Training and Research Hospital, Medical Biochemistry, Amasya, Turkey - ²Afyonkarahisar Health science University, Medical Faculty, Department of Pulmonology, Afyonkarahisar, Turkey

Introduction: Although the increase in cardiac troponins (cTn) in COVID-19 patients has gained importance in the literature, the mechanism of increase has not been fully elucidated. However, it has been a matter of debate whether the rise in cTn has significance in terms of the acute coronary syndrome (ACS) in COVID-19 patients. Our study aims to shed light on these points.

Materials and methods: This retrospective study includes 179 patients, 64% male, mean age 64.6, with COVID-19 disease and without ACS or myocardial infarction (MI). Demographic, clinical, and laboratory variables were provided from medical records. The cTn measurements of outpatients were made on the day of admission, the measurements of the patients who were hospitalized in the service were made on the third day after the admission, the measurements of the discharged patients were made between the 9th and 11th days after the admission, and the measurements of the patients admitted to the intensive care unit were made between the 13th and 15th days following the admission. 

Results: While the cTnI values on the third day of hospitalization were significantly higher than the first examination values, the cTnI values of the discharged patients (mean: 0.18 ug/L) were significantly lower than the values on the third day of admission (mean: 0.33 ug/L) and hospitalization (mean: 0.24 ug/L). ICU patients had significantly higher cTnI values (mean: 0.57 ug/L) than other cTnI measurements ((mean: 0.24 ug/L), (mean: 0.33 ug/L), (mean: 0.18 ug/L)). ECG data of the patients were insignificant in terms of ACS or MI, and no complaints or physical examination findings due to typical cardiac pathologies were found in any patient. The coronary angiographic procedure was not applied to any patient.

Conclusion: It is meaningful to check cTn for the first examination and follow-up in COVID-19 patients. On the other hand, in COVID-19 patients who do not clinically comply with the ACS or MI picture, cTn increases do not provide sufficient contribution for ACS and planned interventional procedures. However, it should not be forgotten that each cTn increase has a vital value and must be investigated.