CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 1, January–April 2023 16 AFRICA The impact of daily troponin I and D-dimer serum levels on mortality in COVID-19 pneumonia patients Berna Stavileci, Emrah Ereren, Emrah Özdemir, Bahar Özdemir, Mahir Cengiz, Rasim Enar Abstract Background: Coronavirus disease 2019 (COVID-19) is an infection resulting in very high morbidity and mortality rates globally. Limited data are available on the cardiovascular manifestations in these patients. The aim of this study was to analyse the daily troponin I and D-dimer levels and their impact on the need for intensive care and on mortality rates of COVID-19-infected patients. Methods: Two-hundred and five patients who were hospitalised between 20 March and 5 May 2020, with a diagnosis of moderate-to-severe COVID-19 pneumonia, were analysed retrospectively. Serum troponin I and D-dimer levels were recorded for at least 10 days after admission. Results: The average age was higher in the group of patients who died compared to the group who were discharged (67.79 ± 14.9 vs 56.87 ± 18.15 years, respectively, p < 0.001). The presence of hypertension, diabetes mellitus, previous coronary bypass surgery, heart failure, chronic renal failure and chronic obstructive pulmonary disease statistically significantly affected mortality rates (p = 0.003, 0.004, 0.045, 0.02, 0.003, 0.007, respectively). The first 10 days of measurements of troponin I and D-dimer were associated with intensive care requirements and mortality (p < 0.001). Both troponin I and D-dimer were higher in the group who died compared to the patients requiring intensive care. Troponin I values of ≥ 16.05 pg/ml on the seventh day were related to the need for intensive care [area under the curve (AUC) 0.896, sensitivity 78.6%, specificity 78.3%, p < 0.001). Troponin I values ≥ 30.25 pg/ml on the ninth day were related to mortality (AUC 0.920, sensitivity 89.5%, specificity 89.3%, p < 0.001). D-dimer values ≥ 878 hg/ml on the second day were associated with intensive care need (AUC 0.896, sensitivity 78.6%, specificity 78.3%, p < 0.001). D-dimer values ≥ 1 106 hg/ml on the 10th day were associated with mortality (AUC 0.817, sensitivity 68.4%, specificity 65.2%, p < 0.001). It was observed that hospitalisation periods ≥ 9.5 days were associated with mortality (AUC 0.738, sensitivity 68.4%, specificity 65.9%, p < 0.001). Conclusion: We showed that hospitalisations ≥ 9.5 days in duration were related to increased mortality rates. Troponin I and D-dimer follow-up values in the serum were more effective than other inflammatory markers in predicting mortality and the need for intensive care. A high troponin I value should alert the clinician in terms of clinical deterioration. Keywords: COVID-19, daily D-dimer, length of hospitalisation, mortality, SARS-CoV2, daily troponin I Submitted 18/4/21, accepted 1/4/22 Published online 16/5/22 Cardiovasc J Afr 2023; 34: 16–22 www.cvja.co.za DOI: 10.5830/CVJA-2022-017 Coronavirus disease 2019 (COVID-19) was first reported in December 2019 and since then has become a pandemic, resulting in very high morbidity and mortality rates globally.1 The virus mainly infects people by attaching to the angiotensin converting enzyme 2 (ACE-2) receptor in the lungs.2 The heart and blood vessels may also be targeted by the virus due to their ACE-2 receptors, although the extent of that impact is not known.2 Information related to the damage caused in the heart is limited.1 Acute cardiac injury was defined as elevation of serum troponin levels among patients hospitalised due to COVID-19 in Wuhan and was linked with higher mortality rates.1 Significantly higher cardiac troponin levels were detected in patients with more severe infection, who were admitted to the intensive care unit (ICU) and who died.2 Other than myocarditis, cardiac injury occurred due to non-ischaemic myocardial processes, for example severe respiratory system infection, hypoxia, sepsis, systemic inflammation, pulmonary thromboembolism and cardiac adrenergic hyperstimulation caused by a cytokine storm.2 Limited data are available on cardiovascular manifestations in these patients. However, a relationship has been shown between poor outcomes in patients and a history of cardiovascular diseases and/or the development of acute cardiac injury in those patients.3-5 Risk factors causing clinical deterioration are not well known. There is no research analysing the increase in troponin I levels in the days following admission. The relationship between daily troponin I and D-dimer serum levels during a cytokine storm, duration of hospitalisation and mortality rate is not known. The goal of our research was to analyse the daily troponin I and D-dimer levels and their impact on the need for intensive care and on mortality of COVID-19 patients with moderate-to-severe pneumonia. Department of Cardiology, Biruni University Faculty of Medicine, Küçükçekmece, Istanbul, Turkey Berna Stavileci, MD, bernastavileci@hotmail.com Emrah Özdemir, MD Department of Cardiovascular Surgery, Samsun Training and Research Hospital, Ilkadim, Samsun, Turkey Emrah Ereren, MD Department of Internal Medicine, Istanbul Bakirköy Dr Sadi Konuk Training and Research Hospital, Bakırköy, Istanbul, Turkey Bahar Özdemir, MD Department of Internal Medicine, Biruni University Faculty of Medicine, Küçükçekmece, Istanbul, Turkey Mahir Cengiz, MD Department of Cardiology, Istanbul University Cerrahpaşa Medical Faculty, Cerrahpaşa-Fatih, Istanbul, Turkey Rasim Enar, MD
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