The really exciting finding from this research is that the heart acts as a highly sensitive integrated sensor of global stress in severe COVID pneumonitis such that, the troponin level at admission to intensive care is the most powerful predictor of survival, apart from age, and better than conventional risk scores in fact.Professor Divaka Perera, Consultant Cardiologist and Senior author of the paper
22 February 2021
Researchers examine impact of troponin on patients with COVID-19 lung disease
A team of researchers look to determine the effects of troponin on survival rate.
This research, which involved a collaborative effort between clinicians and academics working in intensive care and cardiology at Guy’s & St Thomas’ Hospital and from the KCL School of Cardiovascular Medicine & Sciences, looked at patients with COVID-19 lung disease admitted to the intensive care unit (ICU) in order to determine the effects of troponin on survival.
Early in the course of the pandemic, reports from around the world (including Italy, China and the USA) suggested that there is often an increase in the levels of cardiac biomarkers, such as troponin, in the blood of patients needing admission to the ICU. However, it was not clear if COVID-19 was causing direct damage to the heart muscle and whether these increased levels of biomarkers are associated with patient outcomes.
The researchers studied patients with severe lung disease caused by COVID-19 who were admitted to the ICU at Guy’s and St Thomas’ Hospital, one of the busiest units in Europe during the first wave, with comprehensive assessment including echocardiography to check heart function. In a paper published in the American Journal of Cardiology, Dr Ozan Demir and colleagues reported that Troponin is frequently elevated in this cohort but that the degree of elevation was usually minimal, with preserved heart function in most patients. Even minimal elevation of troponin proved to be a powerful predictor of survival, better than conventional ICU risk scores.
The study is also notable for being one of the largest sets of extremely ill COVID-19 patients to be reported on from a single centre and the first of its kind in the U.K.
This study provides new and important data on the role of biomarkers (i.e., troponin) in the stratification of patients with COVID-19 pneumonitis who may be at risk of adverse outcomes.Also, the study confirms the important role of vascular inflammation and endothelial disease in COVID-19. Whether the risk and the biomarkers are modified by immunomodulation (e.g Tocilizumab) or steroids (e.g. Dexamethasone) will be important to establish and is the next important research question.Dr Luigi Camporota, Consultant in Intensive Care and study coauthor
The potential next steps for this research involve using this biomarker to help guide the management of patients and change how they are treated in ICU. Larger scale observational data would help to build a better picture and pave the way for clinical trials.