Troponin and other biomarker levels and outcomes among patients hospitalized with COVID-19: Derivation and validation of the Ha₂T₂ COVID-19 mortality risk score

BACKGROUND: The independent prognostic value of troponin and other biomarker elevation among patients with coronavirus disease 2019 (COVID-19) are unclear. We sought to characterize biomarker levels in patients hospitalized with COVID-19 and develop and validate a mortality risk score. METHODS AND RESULTS: An observational cohort study of 1053 patients with COVID-19 was conducted. Patients with all of the following biomarkers measured—troponin-I, B-type natriuretic peptide, C-reactive protein, ferritin, and d-dimer (n=446) —were identified. Maximum levels for each biomarker were recorded. The primary end point was 30-day in-hospital mortal-ity. Multivariable logistic regression was used to construct a mortality risk score. Validation of the risk score was performed using an independent patient cohort (n=440). Mean age of patients was 65.0±15.2 years and 65.3% were men. Overall, 444 (99.6%) had elevation of any biomarker. Among tested biomarkers, troponin-I ≥0.34 ng/mL was the only independent predictor of 30-day mortality (adjusted odds ratio, 4.38; P<0.001). Patients with a mortality score using hypoxia on presentation, age, and troponin-I elevation, age (HA₂ T₂ ) ≥3 had a 30-day mortality of 43.7% while those with a score <3 had mortality of 5.9%. Area under the receiver operating characteristic curve of the HA₂ T₂ score was 0.834 for the derivation cohort and 0.784 for the validation cohort. CONCLUSIONS: Elevated troponin and other biomarker levels are commonly seen in patients hospitalized with COVID-19. High troponin levels are a potent predictor of 30-day in-hospital mortality. A simple risk score can stratify patients at risk for COVID-19–associated mortality.