Cardiac troponin I in SARS-CoV-2-patients: the additional prognostic value of serial monitoring

Zaninotto, Martina; Maria Mion, Monica; Padoan, Andrea; Babuin, Luciano; Plebani, Mario

Background Major cardiac complications have been described in SARS-CoV-2 patients. The study of cardiac troponin’ kinetic release is the recommended approach to differentiate acute from chronic injury, in order to clinically manage different cardiac diseases. Aim To investigate whether serial measurements of high sensitivity troponin I (hs-cTnI) might provide additional information in SARS-CoV-2 patients’s clinical management. Methods 113 consecutive patients suffering from microbiology proven SARS-CoV2-infection have been studied. Hs-cTnI has been measured in lithium-heparin plasma samples using STAT High Sensitive Troponin I (Architect i2000, Abbott Diagnostics), being 99th percentiles 16 and 34 ng/L for females and males respectively. Results In 69 out of 113 patients hs-cTnI has been measured, showing in 31 (45%) values higher than 99th percentiles in at least one occasion. In 50 patients (72%) a kinetic evaluation (at least 2 measurements during 24 h) has been carried out. Patients were subdivided into five groups: 1 (n=44) and 2 (n=19) no measurement of hs-cTnI or no monitoring respectively; 3 (n=15) no significant variations during monitoring; 4 (n=8) and 5 (n=27) significant variations with values persistently below or sometimes higher than 99th percentiles, respectively. Group 5 patients had a longer hospital stay (median 37 days, p=0.0001), a more aggressive disease (6 out of 27, 22%, died), more often need admission to ICU (n=25, 92.6%, p<0.0001), and show one or more peak values, sometime preceded by severe hypoxia. Conclusions In SARS-CoV-2 patients, hs-cTnI serial monitoring may provide additional data to stratify risk, establish prognosis and gaining epidemiological insight on cardiac involvement in this pandemic disease.