Normal high-sensitivity cardiac troponin for ruling-out inpatient mortality in acute COVID-19

Alexander Liu; Robert Hammond; Kenneth Chan; Chukwugozie Chukwuenweniwe; Rebecca Johnson; Duaa Khair; Eleanor Duck; Oluwaseun Olubodun; Kristian Barwick; Winston Banya; James Stirrup; Peter D. Donnelly; Juan Carlos Kaski; Anthony R. M. Coates

doi:10.1371/journal.pone.0284523

Normal high-sensitivity cardiac troponin for ruling-out inpatient mortality in acute COVID-19

Alexander Liu, Robert Hammond, Kenneth Chan, Chukwugozie Chukwuenweniwe, Rebecca Johnson, Duaa Khair, Eleanor Duck, Oluwaseun Olubodun, Kristian Barwick, Winston Banya, James Stirrup, Peter D. Donnelly, Juan Carlos Kaski, Anthony R. M. Coates^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Introduction

Assessment of inpatient mortality risk in COVID-19 patients is important for guiding clinical decision-making. High sensitivity cardiac troponin T (hs-cTnT) is a biomarker of cardiac injury associated with a worse prognosis in COVID-19. We explored how hs-cTnT could potentially be used in clinical practice for ruling in and ruling out mortality in COVID-19.

Method

We tested the diagnostic value of hs-cTnT in laboratory-confirmed COVID-19 patients (≥18 years old) admitted to the Royal Berkshire Hospital (UK) between 1^st March and 10^th May 2020. A normal hs-cTnT was defined as a value within the 99^th percentile of healthy individuals (≤14 ng/L), and an elevated hs-cTnT was defined as >14 ng/L. Adverse clinical outcome was defined as inpatient mortality related to COVID-19.

Results

A total of 191 COVID-19 patients (62% male; age 66±16 years) had hs-cTnT measured on admission. Of these patients, 124 (65%) had elevated hs-cTnT and 67 (35%) had normal hs-cTnT. On a group level, patients with elevated hs-cTnT had worse inpatient survival (p = 0.0014; Kaplan-Meier analysis) and higher risk of inpatient mortality (HR 5.84 [95% CI 1.29–26.4]; p = 0.02; Cox multivariate regression) compared to patients with normal hs-cTnT. On a per-patient level, a normal hs-cTnT had a negative predictive value of 94% (95% CI: 85–98%) for ruling out mortality, whilst an elevated hs-cTnT had a low positive predictive value of 38% (95% CI: 39–47%) for ruling in mortality.

Conclusions

In this study cohort of COVID-19 patients, the potential clinical utility of hs-cTnT appears to rest in ruling out inpatient mortality. This finding, if prospectively validated in a larger study, may allow hs-cTnT to become an important biomarker to facilitate admission-avoidance and early safe discharge.

Original language	English
Article number	e0284523
Number of pages	15
Journal	PLoS ONE
Volume	18
Issue number	4
DOIs	https://doi.org/10.1371/journal.pone.0284523
Publication status	Published - 21 Apr 2023

Keywords

COVID-19

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1371/journal.pone.0284523Licence: CC BY

Liu_2023_PLOSONE_Normalhigh-sensitivity_CC
Copyright: © 2023 Liu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Final published version, 1.15 MBLicence: CC BY

Cite this

@article{a5007be87a3c4c49abd176250d0d18f7,

title = "Normal high-sensitivity cardiac troponin for ruling-out inpatient mortality in acute COVID-19",

abstract = "IntroductionAssessment of inpatient mortality risk in COVID-19 patients is important for guiding clinical decision-making. High sensitivity cardiac troponin T (hs-cTnT) is a biomarker of cardiac injury associated with a worse prognosis in COVID-19. We explored how hs-cTnT could potentially be used in clinical practice for ruling in and ruling out mortality in COVID-19.MethodWe tested the diagnostic value of hs-cTnT in laboratory-confirmed COVID-19 patients (≥18 years old) admitted to the Royal Berkshire Hospital (UK) between 1st March and 10th May 2020. A normal hs-cTnT was defined as a value within the 99th percentile of healthy individuals (≤14 ng/L), and an elevated hs-cTnT was defined as >14 ng/L. Adverse clinical outcome was defined as inpatient mortality related to COVID-19.ResultsA total of 191 COVID-19 patients (62% male; age 66±16 years) had hs-cTnT measured on admission. Of these patients, 124 (65%) had elevated hs-cTnT and 67 (35%) had normal hs-cTnT. On a group level, patients with elevated hs-cTnT had worse inpatient survival (p = 0.0014; Kaplan-Meier analysis) and higher risk of inpatient mortality (HR 5.84 [95% CI 1.29–26.4]; p = 0.02; Cox multivariate regression) compared to patients with normal hs-cTnT. On a per-patient level, a normal hs-cTnT had a negative predictive value of 94% (95% CI: 85–98%) for ruling out mortality, whilst an elevated hs-cTnT had a low positive predictive value of 38% (95% CI: 39–47%) for ruling in mortality.ConclusionsIn this study cohort of COVID-19 patients, the potential clinical utility of hs-cTnT appears to rest in ruling out inpatient mortality. This finding, if prospectively validated in a larger study, may allow hs-cTnT to become an important biomarker to facilitate admission-avoidance and early safe discharge.",

keywords = "COVID-19",

author = "Alexander Liu and Robert Hammond and Kenneth Chan and Chukwugozie Chukwuenweniwe and Rebecca Johnson and Duaa Khair and Eleanor Duck and Oluwaseun Olubodun and Kristian Barwick and Winston Banya and James Stirrup and Donnelly, {Peter D.} and Kaski, {Juan Carlos} and Coates, {Anthony R. M.}",

year = "2023",

month = apr,

day = "21",

doi = "10.1371/journal.pone.0284523",

language = "English",

volume = "18",

journal = "PLoS ONE",

issn = "1932-6203",

publisher = "Public Library of Science",

number = "4",

}

TY - JOUR

T1 - Normal high-sensitivity cardiac troponin for ruling-out inpatient mortality in acute COVID-19

AU - Liu, Alexander

AU - Hammond, Robert

AU - Chan, Kenneth

AU - Chukwuenweniwe, Chukwugozie

AU - Johnson, Rebecca

AU - Khair, Duaa

AU - Duck, Eleanor

AU - Olubodun, Oluwaseun

AU - Barwick, Kristian

AU - Banya, Winston

AU - Stirrup, James

AU - Donnelly, Peter D.

AU - Kaski, Juan Carlos

AU - Coates, Anthony R. M.

PY - 2023/4/21

Y1 - 2023/4/21

N2 - IntroductionAssessment of inpatient mortality risk in COVID-19 patients is important for guiding clinical decision-making. High sensitivity cardiac troponin T (hs-cTnT) is a biomarker of cardiac injury associated with a worse prognosis in COVID-19. We explored how hs-cTnT could potentially be used in clinical practice for ruling in and ruling out mortality in COVID-19.MethodWe tested the diagnostic value of hs-cTnT in laboratory-confirmed COVID-19 patients (≥18 years old) admitted to the Royal Berkshire Hospital (UK) between 1st March and 10th May 2020. A normal hs-cTnT was defined as a value within the 99th percentile of healthy individuals (≤14 ng/L), and an elevated hs-cTnT was defined as >14 ng/L. Adverse clinical outcome was defined as inpatient mortality related to COVID-19.ResultsA total of 191 COVID-19 patients (62% male; age 66±16 years) had hs-cTnT measured on admission. Of these patients, 124 (65%) had elevated hs-cTnT and 67 (35%) had normal hs-cTnT. On a group level, patients with elevated hs-cTnT had worse inpatient survival (p = 0.0014; Kaplan-Meier analysis) and higher risk of inpatient mortality (HR 5.84 [95% CI 1.29–26.4]; p = 0.02; Cox multivariate regression) compared to patients with normal hs-cTnT. On a per-patient level, a normal hs-cTnT had a negative predictive value of 94% (95% CI: 85–98%) for ruling out mortality, whilst an elevated hs-cTnT had a low positive predictive value of 38% (95% CI: 39–47%) for ruling in mortality.ConclusionsIn this study cohort of COVID-19 patients, the potential clinical utility of hs-cTnT appears to rest in ruling out inpatient mortality. This finding, if prospectively validated in a larger study, may allow hs-cTnT to become an important biomarker to facilitate admission-avoidance and early safe discharge.

AB - IntroductionAssessment of inpatient mortality risk in COVID-19 patients is important for guiding clinical decision-making. High sensitivity cardiac troponin T (hs-cTnT) is a biomarker of cardiac injury associated with a worse prognosis in COVID-19. We explored how hs-cTnT could potentially be used in clinical practice for ruling in and ruling out mortality in COVID-19.MethodWe tested the diagnostic value of hs-cTnT in laboratory-confirmed COVID-19 patients (≥18 years old) admitted to the Royal Berkshire Hospital (UK) between 1st March and 10th May 2020. A normal hs-cTnT was defined as a value within the 99th percentile of healthy individuals (≤14 ng/L), and an elevated hs-cTnT was defined as >14 ng/L. Adverse clinical outcome was defined as inpatient mortality related to COVID-19.ResultsA total of 191 COVID-19 patients (62% male; age 66±16 years) had hs-cTnT measured on admission. Of these patients, 124 (65%) had elevated hs-cTnT and 67 (35%) had normal hs-cTnT. On a group level, patients with elevated hs-cTnT had worse inpatient survival (p = 0.0014; Kaplan-Meier analysis) and higher risk of inpatient mortality (HR 5.84 [95% CI 1.29–26.4]; p = 0.02; Cox multivariate regression) compared to patients with normal hs-cTnT. On a per-patient level, a normal hs-cTnT had a negative predictive value of 94% (95% CI: 85–98%) for ruling out mortality, whilst an elevated hs-cTnT had a low positive predictive value of 38% (95% CI: 39–47%) for ruling in mortality.ConclusionsIn this study cohort of COVID-19 patients, the potential clinical utility of hs-cTnT appears to rest in ruling out inpatient mortality. This finding, if prospectively validated in a larger study, may allow hs-cTnT to become an important biomarker to facilitate admission-avoidance and early safe discharge.

KW - COVID-19

U2 - 10.1371/journal.pone.0284523

DO - 10.1371/journal.pone.0284523

M3 - Article

SN - 1932-6203

VL - 18

JO - PLoS ONE

JF - PLoS ONE

IS - 4

M1 - e0284523

ER -

Normal high-sensitivity cardiac troponin for ruling-out inpatient mortality in acute COVID-19

Abstract

Keywords

UN SDGs

Access to Document

Fingerprint

Cite this