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Negative Troponin I as a Predictor of Survival in SARS-Cov-2 (COVID-19)

Background: As the number of fatalities due to SARS-CoV-2 (COVID-19) continues to escalate, health care systems are directly affected by the struggle to provide care for patients with and without COVID-19. Little is known regarding the significance of a negative troponin I as a prognosticator in COVID-19.Methods: This is a retrospective analysis of 87,817 patients with COVID-19 admitted to any HCA Healthcare facility in the United States between 03/01/2020 and 03/01//2021. Patients older than 18 years of age were divided into two groups based on their troponin I level from hour 0-24 of admission (positive > 0·1ng/ml or > 30 ng/l if high sensitivity) vs. negative). The primary outcome was all-cause in-hospital mortality. Secondary outcomes included length of stay (LOS), in-hospital and cardiac complications.Results: A total of 66,562 patients met inclusion criteria of which 31,250/66,562 (46.95%) were women with a median age of 67 (IQR: 55-78) years. In-hospital mortality or discharge to hospice occurred in 11,927/66,562 (17·92%) patients. Patients with a negative troponin I in the first 24 hours of admission had lower odds of in-hospital mortality (OR: 0·33, p <0·01). A negative troponin I had a negative predictive value (NPV) of 85·7% (CI: 85·4% - 86·0%) for in-hospital mortality. In-hospital complications, including cardiac, and LOS were worse amongst those with a positive troponin I.Conclusion: A negative troponin I in the first 24 hours of presentation has a high NPV for in-hospital mortality, thereby predicting favorable survival at the time of discharge.Funding Information: None.Declaration of Interests: There are no relationships with any industry. All authors have reported that they have no relationships relevant to the contents of this paper to disclose.Ethics Approval Statement: The Institutional Review Board (IRB) at University of Miami/JFK Medical Center approved this study.