Troponin and short-term mortality in hospitalised patients with COVID-19 infection: a retrospective study in an inner-city London hospital

  1. Vijay Shyam-Sundar
  2. Dan Fredman Stein
  3. Martina Spazzapan
  4. Andrew Sullivan
  5. Cathy Qin
  6. Victor Voon

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Abstract

To investigate the association between troponin positivity in patients hospitalised with COVID-19 and increased mortality in the short term.

Setting

Homerton University Hospital, an inner-city district general hospital in East London.

Design

A single-centre retrospective observational study.

Participants

All adults admitted with swab-proven RT-PCR COVID-19 to Homerton University Hospital from 4 February 2020 to 30 April 2020 (n=402).

Outcome measures

We analysed demographic and biochemical data collected from the patient record according to the primary outcome of death at 28 days during hospital admission.

Methods

Troponin positivity was defined above the upper limit of normal according to our local laboratory assay (>15.5 ng/L for females, >34 ng/L for males). Univariate and multivariate logistical regression analyses were performed to evaluate the link between troponin positivity and death.

Results

Mean age was 65.3 years for men compared with 63.8 years for women. A χ 2 test showed survival of patients with COVID-19 was significantly higher in those with a negative troponin (p=3.23×10 −10 ) compared with those with a positive troponin. In the multivariate logistical regression, lung disease, age, troponin positivity and continuous positive airway pressure were all significantly associated with death, with an area under the curve of 0.889, sensitivity of 0.886 and specificity of 0.629 for the model. Within this model, troponin positivity was independently associated with short-term mortality (OR 2.97, 95% CI 1.34 to 6.61, p=0.008).

Conclusions

We demonstrated an independent association between troponin positivity and increased short-term mortality in COVID-19 in a London district general hospital.

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  1. Version published to 10.1136/bmjopen-2022-061426
  2. ScreenIT

    SciScore for 10.1101/2021.12.23.21268005: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variableThe upper reference limit (URL) of hs-TNI defined as the 99th percentile of hs-TNI distribution in a reference population was 15.5 ng/l for females, and 34 ng/l for males respectively.
    RandomizationManual validation of a random sample of 10% of the dataset was completed.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Laboratory methods: Serum hs-TnI levels were assessed by a high-sensitivity cardiac troponin I microparticle chemiluminescent immunoassay (ARCHITECT STAT, hs-TNI, Abbott) on the fully automated Abbott ARCHITECT analyser (Abbott ARCHITECT STAT high sensitive troponin-I.
    Abbott
    suggested: (Abbott, RRID:SCR_010477)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are some limitations to our findings. First, our sample was a small retrospective analysis of patients with COVID-19 requiring hospitalization. Second, within this cohort of patients, a significant proportion (approximately 20%)did not have blood troponin levelsmeasured and were excluded from the analysis. Furthermore, there were differences in timing of sampling of blood troponin between patients during their hospital stay.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.12.23.21268005v1 on medRxiv