Association of Troponin I, Creatinine, and D-dimer Values with Mortality and ICU Admission among Iranian Patients Hospitalized with COVID-19

COVID-19’s systemic effects, including cardiac injury, necessitate prognostic biomarkers for risk stratification. This study evaluated the utility of troponin I, D-dimer, and creatinine for predicting mortality and ICU admission among hospitalized patients. In a retrospective cohort of 37,703 Iranian COVID-19 patients (2020–2022), biomarkers were assessed at admission. Cox and logistic regression analyses, along with AUC evaluations, were used to examine associations with outcomes, adjusting for demographics, comorbidities, and renal function. Elevated troponin I conferred an 86% higher mortality risk (HR: 1.86, P < 0.001) and a nearly threefold increase in the odds of ICU admission (OR: 2.28, P < 0.001), with superior predictive accuracy (AUC for mortality: 72.6%; for ICU admission: 66.0%). D-dimer and creatinine were moderately associated with mortality and ICU admission. Elevated admission troponin I, D-dimer, and creatinine predicted COVID-19 mortality and ICU admission, reflecting myocardial injury, hypercoagulability, and renal dysfunction. Integrating these biomarkers improved risk stratification and guided acute care management.