High-sensitivity cardiac troponin I for post-COVID cardiovascular risk stratification: A three-year longitudinal cohort study from a South Indian tertiary care centre

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: RT-PCR-confirmed COVID-19 (n=2063). Intervention: Male sex (evaluated with sex-specific high-sensitivity cardiac troponin I [hs-cTnI] thresholds) vs. Female sex. Primary outcome: High-risk subclinical cardiovascular classification among baseline hs-cTnI-negative patients (OR 4.07, 95% CI 2.50–6.60, p=<0.001).

Q: What does this research mean for the field?

Sex-specific hs-cTnI thresholds identify subclinical high cardiovascular risk in 31.8% of clinically troponin-negative COVID-19 patients, with men having over fourfold higher odds of high-risk classification than women. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Deepika Gujjarlapudi; Srihita M .; Vidyavathi Devi Gajapathi Raju; KSS Uma Mahesh; Nageshwar Reddy Duvvur

doi:10.18231/j.ijirm.18779.1791264100

October 16, 2026IP Indian Journal of Immunology and Respiratory MedicineOpen Access

High-sensitivity cardiac troponin I for post-COVID cardiovascular risk stratification: A three-year longitudinal cohort study from a South Indian tertiary care centre

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Key result

Sex-specific troponin thresholds link male sex to ~4.1-fold higher odds of high-risk classification in COVID-19.

OR 4.07
95% CI 2.50–6.60
P<0.001
n=2,063

Why the study?

COVID-19 is associated with persistent cardiovascular complications, and hs-cTnI interpreted using sex-specific thresholds may improve cardiovascular risk stratification across different illness severities.

Does sex-specific hs-cTnI threshold interpretation improve post-COVID subclinical cardiovascular risk stratification and detect six-month risk progression in RT-PCR-confirmed COVID-19 survivors across illness severities?

Study Design

Type

Cohort (n=2,063)

Multicenter

No

Structured PICO

Does sex-specific hs-cTnI threshold interpretation improve post-COVID subclinical cardiovascular risk stratification and detect six-month risk progression in RT-PCR-confirmed COVID-19 survivors across illness severities?

P

Population

2,063 vaccinated adult COVID-19 survivors (30.9% female) without pre-existing cerebrovascular disease, active malignancy, or primary immunodeficiency at a South Indian tertiary care center, followed for 6 months.

E

Exposure

High-sensitivity cardiac troponin I (hs-cTnI) measurement (Abbott ARCHITECT i2000) interpreted using sex-specific HUNT study thresholds (positive: >34 pg/mL in men, >13 pg/mL in women; high-risk: 12-34 pg/mL in men, 10-13 pg/mL in women; moderate-risk: 6-12 pg/mL in men, 4-10 pg/mL in women; low-risk: <6 pg/mL in men, <4 pg/mL in women), alongside concurrent measurement of NT-proBNP, D-dimer, CRP, ferritin, and IL-6.

O

Outcome

Cardiovascular risk stratification category at baseline and six-month risk migration (proportion of patients transitioning between defined hs-cTnI risk categories at 6 months).surrogate

Main Result

Odds Ratio: 4.07 (95% CI 2.5–6.6)

Absolute Event Rate: 38.1% vs 6.1%

p-value: p=<0.001

Sex-specific hs-cTnI thresholds identify substantial subclinical cardiovascular risk in over 60% of binary troponin-negative COVID-19 patients at baseline and reveal progressive upward risk migration over six months across all disease severities, supporting structured post-COVID cardiac surveillance.

Limitations

Retrospective design precludes inference of causality
Absence of a matched non-COVID control group
Selection bias as hs-cTnI was ordered at the discretion of the treating clinician
Lack of variant-level stratification due to absence of systematic genomic sequencing
Sex-specific threshold classification has not been externally validated in an independent Indian cohort
Primary outcome was a biomarker trajectory rather than hard clinical events
Retrospective design precludes the inference of causality.
Absence of a matched non-COVID control group.
Risk of selection bias as hs-cTnI was ordered at the discretion of the treating clinician, likely over-representing more symptomatic cases.
Variant-level stratification was not possible in the absence of systematic genomic sequencing.
Sex-specific threshold classification has not been externally validated in an independent Indian cohort.
Primary outcome was a biomarker trajectory rather than hard clinical events.

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Implication

Sex-specific hs-cTnI thresholds may enhance post-COVID risk stratification; extends HUNT criteria but leaves adoption open pending prospective trials.

Abstract

Background: COVID-19 is associated with persistent cardiovascular complications beyond acute infection. SARS-CoV-2 induces myocardial injury through direct viral invasion, systemic inflammation, endothelial dysfunction, and microvascular thrombosis. High-sensitivity cardiac troponin I (hs-cTnI), interpreted using sex-specific thresholds, enables detection of subclinical myocardial injury and may improve cardiovascular risk stratification. The present study evaluated hs-cTnI-based cardiovascular risk across different COVID-19 illness severities in a South Indian tertiary care population.Materials and Methods: This retrospective longitudinal cohort study included 2,063 RT-PCR-confirmed COVID-19 patients treated at AIG Hospitals, Hyderabad (June 2020–June 2023). Patients were classified as having mild (n = 436), moderate (n = 820), or severe (n = 807) disease according to WHO criteria. Peak hs-cTnI was measured using the Abbott ARCHITECT i2000 and interpreted using sex-specific HUNT study thresholds. NT-proBNP, D-dimer, CRP, ferritin, and IL-6 were measured concurrently. Patients were reassessed at six months. Statistical analyses included chi-square tests, odds ratios, and logistic regression.Results: Elevated hs-cTnI was observed in 52.3% of patients at baseline. Among troponin-negative patients, 31.8% were classified as high risk and 28.3% as moderate risk using sex-specific thresholds. Men had significantly greater odds of high-risk classification than women (OR 4.07, 95% CI 2.50–6.60; p < 0.001). Six-month follow-up demonstrated progression to higher-risk categories across all illness severities, including patients with initially mild disease. D-dimer was elevated in 88.7–92.4% of patients, indicating persistent thromboinflammatory activity.Conclusion: Sex-specific hs-cTnI thresholds identify clinically important subclinical cardiovascular risk after COVID-19 and support structured long-term cardiovascular surveillance.

Discussion

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Cite This Study

Gujjarlapudi et al. (2026) conducted a cohort in RT-PCR-confirmed COVID-19 (n=2,063). Male sex (evaluated with sex-specific high-sensitivity cardiac troponin I [hs-cTnI] thresholds) vs. Female sex was evaluated on High-risk subclinical cardiovascular classification among baseline hs-cTnI-negative patients (OR 4.07, 95% CI 2.50–6.60, p=<0.001).

synapsesocial.com/papers/6ae28e75cbadf70daf6c4272 https://doi.org/10.18231/j.ijirm.18779.1791264100

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High-sensitivity cardiac troponin I for post-COVID cardiovascular risk stratification: A three-year longitudinal cohort study from a South Indian tertiary care centre

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

High-sensitivity cardiac troponin I for post-COVID cardiovascular risk stratification: A three-year longitudinal cohort study from a South Indian tertiary care centre

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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