Normal high-sensitivity cardiac troponin for ruling-out inpatient mortality in acute COVID-19.
<h4>Introduction</h4>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...
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2023-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0284523 |
| _version_ | 1797829876548370432 |
|---|---|
| author | 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 |
| author_facet | 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 |
| author_sort | Alexander Liu |
| collection | DOAJ |
| description | <h4>Introduction</h4>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.<h4>Method</h4>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 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.<h4>Results</h4>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.<h4>Conclusions</h4>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. |
| first_indexed | 2024-04-09T13:28:17Z |
| format | Article |
| id | doaj.art-2dea515a3d5a4c8a94cd56a10f08cb39 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-09T13:28:17Z |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-2dea515a3d5a4c8a94cd56a10f08cb392023-05-10T05:31:43ZengPublic Library of Science (PLoS)PLoS ONE1932-62032023-01-01184e028452310.1371/journal.pone.0284523Normal high-sensitivity cardiac troponin for ruling-out inpatient mortality in acute COVID-19.Alexander LiuRobert HammondKenneth ChanChukwugozie ChukwuenweniweRebecca JohnsonDuaa KhairEleanor DuckOluwaseun OlubodunKristian BarwickWinston BanyaJames StirrupPeter D DonnellyJuan Carlos KaskiAnthony R M Coates<h4>Introduction</h4>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.<h4>Method</h4>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 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.<h4>Results</h4>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.<h4>Conclusions</h4>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.https://doi.org/10.1371/journal.pone.0284523 |
| spellingShingle | 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 Normal high-sensitivity cardiac troponin for ruling-out inpatient mortality in acute COVID-19. PLoS ONE |
| title | Normal high-sensitivity cardiac troponin for ruling-out inpatient mortality in acute COVID-19. |
| title_full | Normal high-sensitivity cardiac troponin for ruling-out inpatient mortality in acute COVID-19. |
| title_fullStr | Normal high-sensitivity cardiac troponin for ruling-out inpatient mortality in acute COVID-19. |
| title_full_unstemmed | Normal high-sensitivity cardiac troponin for ruling-out inpatient mortality in acute COVID-19. |
| title_short | Normal high-sensitivity cardiac troponin for ruling-out inpatient mortality in acute COVID-19. |
| title_sort | normal high sensitivity cardiac troponin for ruling out inpatient mortality in acute covid 19 |
| url | https://doi.org/10.1371/journal.pone.0284523 |
| work_keys_str_mv | AT alexanderliu normalhighsensitivitycardiactroponinforrulingoutinpatientmortalityinacutecovid19 AT roberthammond normalhighsensitivitycardiactroponinforrulingoutinpatientmortalityinacutecovid19 AT kennethchan normalhighsensitivitycardiactroponinforrulingoutinpatientmortalityinacutecovid19 AT chukwugoziechukwuenweniwe normalhighsensitivitycardiactroponinforrulingoutinpatientmortalityinacutecovid19 AT rebeccajohnson normalhighsensitivitycardiactroponinforrulingoutinpatientmortalityinacutecovid19 AT duaakhair normalhighsensitivitycardiactroponinforrulingoutinpatientmortalityinacutecovid19 AT eleanorduck normalhighsensitivitycardiactroponinforrulingoutinpatientmortalityinacutecovid19 AT oluwaseunolubodun normalhighsensitivitycardiactroponinforrulingoutinpatientmortalityinacutecovid19 AT kristianbarwick normalhighsensitivitycardiactroponinforrulingoutinpatientmortalityinacutecovid19 AT winstonbanya normalhighsensitivitycardiactroponinforrulingoutinpatientmortalityinacutecovid19 AT jamesstirrup normalhighsensitivitycardiactroponinforrulingoutinpatientmortalityinacutecovid19 AT peterddonnelly normalhighsensitivitycardiactroponinforrulingoutinpatientmortalityinacutecovid19 AT juancarloskaski normalhighsensitivitycardiactroponinforrulingoutinpatientmortalityinacutecovid19 AT anthonyrmcoates normalhighsensitivitycardiactroponinforrulingoutinpatientmortalityinacutecovid19 |