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Initial High Sensitivity Troponin I Values Predict 28 Day Survival in Coronavirus-19 Patients
OBJECTIVES: To determine the 28 day survival prognostic value of the initial Emergency Department (ED) high sensitivity cardiac troponin I (hs-cTnI) measurement in coronavirus-19 disease 2019 (COVID-19) patients. BACKGROUND: Recent reports indicate that the presence of cardiac injury [troponin level...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Published by Elsevier Inc.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10069991/ http://dx.doi.org/10.1016/j.jemermed.2023.03.009 |
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author | Cook, Bernard Lanfear, David E. Jacobsen, Gordon Moyer, Michele Nowak, Richard M. Linoj, Samuel |
author_facet | Cook, Bernard Lanfear, David E. Jacobsen, Gordon Moyer, Michele Nowak, Richard M. Linoj, Samuel |
author_sort | Cook, Bernard |
collection | PubMed |
description | OBJECTIVES: To determine the 28 day survival prognostic value of the initial Emergency Department (ED) high sensitivity cardiac troponin I (hs-cTnI) measurement in coronavirus-19 disease 2019 (COVID-19) patients. BACKGROUND: Recent reports indicate that the presence of cardiac injury [troponin level > the 99th percentile upper reference limit (99th % URL) using mostly contemporary assays] is predictive of death within 30 days during hospitalization of COVID-19 patients. Troponin values ordered in the ED or after hospitalization were used for these analyses. METHODS: Using an ED centric electronic database of COVID-19 patients (nasopharyngeal swab testing within 1 week prior to or during the ED visit) having at least 1 hs-cTnI (Beckman Coulter, Brea, CA; level of quantitation (LoQ) 4ng/L, non sex specific 99th percentile URL 18 ng/L) value reported during a visit to an urban, academic ED in the United States. All patients were followed for 28 days to determine all-cause mortality. Kaplan Meir survival curves were constructed to compare outcomes amongst predetermined initial hs-cTnI value intervals. RESULTS: From March 16-November 2, 2020 1476 consecutive ED COVID-19 patients were identified with 1044 (70.7%) having at least 1 hs-cTnI value resulted in the ED. Patients’ mean age and body mass index were 60.8 ± 16.1 years and 32.4 ± 11.3 kg/m² respectively. 531 (50.9%) were male, 804 (77.0%) self-identified as African American and 615 (58.9%) had 2 or more comorbidities with hypertension (42.5%), diabetes (37.4%) and hyperlipidemia (27.23%) commonest. Hs-cTnI interval values were: 147 (14.1%) < 4 (LoQ), 359 (34.4%) 4-10 and 151 (14.5%) 11-18 ng/L. Hs-cTnI values were > 99th % URL in 387 (37.1%) patients with 230 (22.0%) 19-54, 63 (6.0%) 54-99 and 94 (9.0%) = 100 (laboratory reported critical value) ng/L. 145 (13.9%) patients were discharged directly home and 2 (0.2%) died in the ED. 147 (14.1%) were admitted to an ICU with 104 (70.7%) dying. Each of the interval initial ED hs-cTnI values was associated with a different (p < 0.001) 28 day survival curve (Figure). CONCLUSION: Most COVID-19 patients had a hs-cTnI value obtained with 85.9% of these > 4 ng/L. No one with an initial hs-cTnI < 4 ng/L died within 28 days while increasing presenting hs-cTnI values > 4 ng/L were associated with decreased 28 day survival. Our findings indicate that in COVID-19 patients detectable initial ED hs-cTnI values, whether reaching thresholds for cardiac injury or not, are highly prognostic of 28 day survival. |
format | Online Article Text |
id | pubmed-10069991 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Published by Elsevier Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-100699912023-04-04 Initial High Sensitivity Troponin I Values Predict 28 Day Survival in Coronavirus-19 Patients Cook, Bernard Lanfear, David E. Jacobsen, Gordon Moyer, Michele Nowak, Richard M. Linoj, Samuel J Emerg Med Article OBJECTIVES: To determine the 28 day survival prognostic value of the initial Emergency Department (ED) high sensitivity cardiac troponin I (hs-cTnI) measurement in coronavirus-19 disease 2019 (COVID-19) patients. BACKGROUND: Recent reports indicate that the presence of cardiac injury [troponin level > the 99th percentile upper reference limit (99th % URL) using mostly contemporary assays] is predictive of death within 30 days during hospitalization of COVID-19 patients. Troponin values ordered in the ED or after hospitalization were used for these analyses. METHODS: Using an ED centric electronic database of COVID-19 patients (nasopharyngeal swab testing within 1 week prior to or during the ED visit) having at least 1 hs-cTnI (Beckman Coulter, Brea, CA; level of quantitation (LoQ) 4ng/L, non sex specific 99th percentile URL 18 ng/L) value reported during a visit to an urban, academic ED in the United States. All patients were followed for 28 days to determine all-cause mortality. Kaplan Meir survival curves were constructed to compare outcomes amongst predetermined initial hs-cTnI value intervals. RESULTS: From March 16-November 2, 2020 1476 consecutive ED COVID-19 patients were identified with 1044 (70.7%) having at least 1 hs-cTnI value resulted in the ED. Patients’ mean age and body mass index were 60.8 ± 16.1 years and 32.4 ± 11.3 kg/m² respectively. 531 (50.9%) were male, 804 (77.0%) self-identified as African American and 615 (58.9%) had 2 or more comorbidities with hypertension (42.5%), diabetes (37.4%) and hyperlipidemia (27.23%) commonest. Hs-cTnI interval values were: 147 (14.1%) < 4 (LoQ), 359 (34.4%) 4-10 and 151 (14.5%) 11-18 ng/L. Hs-cTnI values were > 99th % URL in 387 (37.1%) patients with 230 (22.0%) 19-54, 63 (6.0%) 54-99 and 94 (9.0%) = 100 (laboratory reported critical value) ng/L. 145 (13.9%) patients were discharged directly home and 2 (0.2%) died in the ED. 147 (14.1%) were admitted to an ICU with 104 (70.7%) dying. Each of the interval initial ED hs-cTnI values was associated with a different (p < 0.001) 28 day survival curve (Figure). CONCLUSION: Most COVID-19 patients had a hs-cTnI value obtained with 85.9% of these > 4 ng/L. No one with an initial hs-cTnI < 4 ng/L died within 28 days while increasing presenting hs-cTnI values > 4 ng/L were associated with decreased 28 day survival. Our findings indicate that in COVID-19 patients detectable initial ED hs-cTnI values, whether reaching thresholds for cardiac injury or not, are highly prognostic of 28 day survival. Published by Elsevier Inc. 2023-03 2023-04-04 /pmc/articles/PMC10069991/ http://dx.doi.org/10.1016/j.jemermed.2023.03.009 Text en Copyright © 2023 Published by Elsevier Inc. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | Article Cook, Bernard Lanfear, David E. Jacobsen, Gordon Moyer, Michele Nowak, Richard M. Linoj, Samuel Initial High Sensitivity Troponin I Values Predict 28 Day Survival in Coronavirus-19 Patients |
title | Initial High Sensitivity Troponin I Values Predict 28 Day Survival in Coronavirus-19 Patients |
title_full | Initial High Sensitivity Troponin I Values Predict 28 Day Survival in Coronavirus-19 Patients |
title_fullStr | Initial High Sensitivity Troponin I Values Predict 28 Day Survival in Coronavirus-19 Patients |
title_full_unstemmed | Initial High Sensitivity Troponin I Values Predict 28 Day Survival in Coronavirus-19 Patients |
title_short | Initial High Sensitivity Troponin I Values Predict 28 Day Survival in Coronavirus-19 Patients |
title_sort | initial high sensitivity troponin i values predict 28 day survival in coronavirus-19 patients |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10069991/ http://dx.doi.org/10.1016/j.jemermed.2023.03.009 |
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