The relevance of hs-troponin and global longitudinal strain in predicting the need for mechanical intubation in severe COVID-19 patients

Type of funding sources: Public hospital(s). Main funding source(s): Dr.Soetomo General Hospital Abbott

The occurrence of an imbalance in oxygen supply results in the release of pro-inflammatory cytokines which leads to increased ventilation support requirement. Half of the intubated patients with COVID-19 manifest myocardial injury, which is associated with a graded increase in overall mortality.

This study aims to analyze factors that contribute to worse outcomes among severe COVID-19 infections.

We performed an observational, single-center prospective cohort study from February 1st – July 31st, 2021 at an Isolated ICU. A total of 65 subjects were included. Subjects were recruited according to WHO criteria for severe COVID-19 and CDC criteria for myocarditis. All subjects recruited were examined using echocardiography to measure global longitudinal strain (GLS) and blood samples were taken to measure hs-Troponin. Subjects were then followed to assess their needs for mechanical ventilation and in-hospital mortality.

Severe COVID-19 subjects with cardiac injury were associated with an increased need for intubation (78.5%) and an increased incidence of myocarditis (50.8%). There was an association between the use of intubation and the risk of mortality in patients (66.7% vs. 33.3%, p-value <0.001). Both reduced GLS and increased hs-troponin are associated with increased myocarditis (p-value <0.001 and 0.004 respectively). Reduced GLS is associated with higher mechanical ventilation needs (12.17 + 4.79 vs.15.65 + 4.90, p-value 0.02) and a higher mortality rate (11.36 + 4.64 vs. 14.74 + 4.82; p-value 0.005). Increased hs-troponin is associated with higher mechanical ventilation needs (25.33% vs. 3.56%, p-value 0.002) and a higher mortality rate (34.57% vs. 5.76%, p-value 0.002).

Severe COVID-19 subjects are associated with an increased incidence of myocarditis as indicated by myocardial injury through an increase in hs-troponin and a decrease in GLS. Both increased hs-troponin and reduced GLS are associated with higher mechanical ventilation needs and a higher mortality rate.