511 - Hospitalized COVID-19 Patients with Elevated Cardiac Troponin I Have Increased Length Of Stay But Similar Ventilation Time

Background: Coronavirus disease 2019 (COVID-19) causes increased mortality and morbidity in patients with underlying cardiovascular disease. Elevated cardiac troponin I (cTnI) can suggest either a co-concurrent myocarditis or acute myocardial infarction. Understanding how laboratory values predict disease severity is important for clinicians to guide therapy and triage patients. 

Methods: A cross sectional study was performed utilizing the 184 hospital United States database of HCA. Patients were selected based on inpatient visits to HCA facilities from February 2020 to May 2020 with a COVID-19 diagnosis and at least one cTnI lab test. Patients were divided according to an elevated or normal cTnI value based on the 99th percentile reference range of the test. Outcomes, such as length of stay, disposition, and time on the ventilator, were compared.

Results: 3968 patients hospitalized with COVID-19 were identified. Of those, 3158 patients had at least one cTnI test throughout their hospitalization. 829 (26%) had at least one positive cTnI during their hospitalization. Patients with at least one positive cTnI were hospitalized on average for 8.7 days, whereas patients without positive cTnI were hospitalized on average for 6.3 days (p< 0.0001). 1499 patients without positive cTnI were sent home without health care, but only 196 with positive cTnI were discharged home without requiring home health (p < 0.0001). Need for mechanical ventilation was also higher in the elevated cTnI group. If intubated, patients in both groups required on average the same amount of ventilator time, 7 days (p = 0.7263).Ventilation time between COVID-19 patients with and without elevated Troponins
Length of hospitalization stay between COVID-19 patient with and without elevated Troponins
Differences in discharge between COVID-19 patients with and without elevated Troponins


Conclusion: Patients with at least one positive cTnI during their hospitalization had increased length of stay and decreased likelihood of being discharged home without home health. Using a large nationwide database we confirmed previously published findings in smaller patient populations associating cardiovascular disease with COVID-19 severity. Once patients were intubated, both subsets of patients with and without elevated cTnI had similar days on the ventilator, suggesting the COVID-19 acute respiratory distress syndrome (ARDS) has a more complicated relationship to troponin levels. These findings suggest that patients with an increased cTnI should be triaged to receive aggressive management.