Cardiac troponin and COVID‐19 severity: Results from BIOCOVID study

García de Guadiana‐Romualdo, Luis; Morell‐García, Daniel; Rodríguez‐Fraga, Olaia; Morales‐Indiano, Cristian; María Lourdes Padilla Jiménez, Ana; Gutiérrez Revilla, José Ignacio; Urrechaga, Eloísa; Álamo, José María; Hernando Holgado, Ana María; Lorenzo‐Lozano, María del Carmen; Sánchez Fdez‐Pacheco, Silvia; de la Hera Cagigal, Patricia; Juncos Tobarra, María Ángeles; Vílchez, Juan A.; Vírseda Chamorro, Isabel; Gutiérrez Garcia, Irene; Pastor Murcia, Yolanda; Sahuquillo Frías, Laura; Altimira Queral, Laura; Nuez‐Zaragoza, Elisa; Adell Ruiz de León, Juan; Ruiz Ripa, Alicia; Salas Gómez‐Pablos, Paloma; Cebreiros López, Iria; Fernández Uriarte, Amaia; Larruzea, Álex; López Yepes, María Luisa; Sancho‐Rodríguez, Natalia; Zamorano Andrés, María Consuelo; Pedregosa Díaz, José; Acevedo Alcaraz, Cristina; Blázquez Manzanera, Alfonso‐L; Pérez Sanmartín, Sonia; Baamonde Calzada, María del Carmen; Vera, Marina; Valera Nuñez, Elena; Canalda Campás, Magdalena; García Muñoz, Sara; Bauça, Josep Miquel; Vicente Gutiérrez, Luis; Jiménez Añón, Laura; Pérez Martínez, Alfonso; Pons Castillo, Aurelio; González Tamayo, Ruth; Férriz Vivancos, Jorge; José Alcaide Martín, María; Ferrer Díaz de Brito Fernández, Vicente; Aguadero, Vicente; García Arévalo, María Gloria; Arnaldos Carrillo, María; González Morales, Mercedes; Núñez Gárate, María; Ruiz Iruela, Cristina; Esteban Torrella, Patricia; Vila Pérez, Martí; Egea‐Caparrós, Jose Manuel; Sáenz, Luis; Galán Ortega, Amparo; Consuegra‐Sánchez, Luciano

BACKGROUND: Myocardial injury is a common finding in COVID‐19 strongly associated with severity. We analysed the prevalence and prognostic utility of myocardial injury, characterized by elevated cardiac troponin, in a large population of COVID‐19 patients, and further evaluated separately the role of troponin T and I. METHODS: This is a multicentre, retrospective observational study enrolling patients with laboratory‐confirmed COVID‐19 who were hospitalized in 32 Spanish hospitals. Elevated troponin levels were defined as values above the sex‐specific 99th percentile upper reference limit, as recommended by international guidelines. Thirty‐day mortality was defined as endpoint. RESULTS: A total of 1280 COVID‐19 patients were included in this study, of whom 187 (14.6%) died during the hospitalization. Using a nonspecific sex cut‐off, elevated troponin levels were found in 344 patients (26.9%), increasing to 384 (30.0%) when a sex‐specific cut‐off was used. This prevalence was significantly higher (42.9% vs 21.9%; P < .001) in patients in whom troponin T was measured in comparison with troponin I. Sex‐specific elevated troponin levels were significantly associated with 30‐day mortality, with adjusted odds ratios (ORs) of 3.00 for total population, 3.20 for cardiac troponin T and 3.69 for cardiac troponin I. CONCLUSION: In this multicentre study, myocardial injury was a common finding in COVID‐19 patients. Its prevalence increased when a sex‐specific cut‐off and cardiac troponin T were used. Elevated troponin was an independent predictor of 30‐day mortality, irrespective of cardiac troponin assay and cut‐offs to detect myocardial injury. Hence, the early measurement of cardiac troponin may be useful for risk stratification in COVID‐19.