Cardiac injury and mortality in patients with Coronavirus disease 2019 (COVID-19): insights from a mediation analysis

Abstract Backgrounds Patients at greatest risk of severe clinical conditions from coronavirus disease 2019 (COVID-19) and death are elderly and comorbid patients. Increased levels of cardiac troponins identify patients with poor outcome. The present study aimed to describe the clinical characteristics and outcomes of a cohort of Italian inpatients, admitted to a medical COVID-19 Unit, and to investigate the relative role of cardiac injury on in-hospital mortality. Methods and results We analyzed all consecutive patients with laboratory-confirmed COVID-19 referred to our dedicated medical Unit between February 26th and March 31st 2020. Patients’ clinical data including comorbidities, laboratory values, and outcomes were collected. Predictors of in-hospital mortality were investigated. A mediation analysis was performed to identify the potential mediators in the relationship between cardiac injury and mortality. A total of 109 COVID-19 inpatients (female 36%, median age 71 years) were included. During in-hospital stay, 20 patients (18%) died and, compared with survivors, these patients were older, had more comorbidities defined by Charlson comorbidity index ≥ 3(65% vs 24%, p = 0.001), and higher levels of high-sensitivity cardiac troponin I (Hs-cTnI), both at first evaluation and peak levels. A dose–response curve between Hs-cTnI and in-hospital mortality risk up to 200 ng/L was detected. Hs-cTnI, chronic kidney disease, and chronic coronary artery disease mediated most of the risk of in-hospital death, with Hs-cTnI mediating 25% of such effect. Smaller effects were observed for age, lactic dehydrogenase, and d-dimer. Conclusions In this cohort of elderly and comorbid COVID-19 patients, elevated Hs-cTnI levels were the most important and independent mediators of in-hospital mortality.

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Myocardial injury is associated with in-hospital mortality of confirmed or suspected COVID-19 in Wuhan, China: A single center retrospective cohort study

10.1101/2020.03.21.20040121 ◽

2020 ◽

Cited By ~ 13

Author(s):

Fan Zhang ◽

Deyan Yang ◽

Jing Li ◽

Peng Gao ◽

Taibo Chen ◽

...

Keyword(s):

Risk Factors ◽

Hospital Mortality ◽

Cardiac Troponin ◽

Troponin I ◽

Cox Regression ◽

Cardiac Injury ◽

High Sensitivity ◽

Hospital Death ◽

Cox Regression Analysis ◽

D Dimer

AbstractBackgroundSince December 2019, a cluster of coronavirus disease 2019 (COVID-19) occurred in Wuhan, Hubei Province, China and spread rapidly from China to other countries. In-hospital mortality are high in severe cases and cardiac injury characterized by elevated cardiac troponin are common among them. The mechanism of cardiac injury and the relationship between cardiac injury and in-hospital mortality remained unclear. Studies focused on cardiac injury in COVID-19 patients are scarce.ObjectivesTo investigate the association between cardiac injury and in-hospital mortality of patients with confirmed or suspected COVID-19.MethodsDemographic, clinical, treatment, and laboratory data of consecutive confirmed or suspected COVID-19 patients admitted in Wuhan No.1 Hospital from 25th December, 2019 to 15th February, 2020 were extracted from electronic medical records and were retrospectively reviewed and analyzed. Univariate and multivariate Cox regression analysis were used to explore the risk factors associated with in-hospital death.ResultsA total of 110 patients with confirmed (n=80) or suspected (n=30) COVID-19 were screened and 48 patients (female 31.3%, mean age 70.58±13.38 year old) among them with high-sensitivity cardiac troponin I (hs-cTnI) test within 48 hours after admission were included, of whom 17 (17/48, 35.4%) died in hospital while 31 (31/48, 64.6%) were discharged or transferred to other hospital. High-sensitivity cardiac troponin I was elevated in 13 (13/48, 27.1%) patents. Multivariate Cox regression analysis showed pulse oximetry of oxygen saturation (SpO2) on admission (HR 0.704, 95% CI 0.546-0.909, per 1% decrease, p=0.007), elevated hs-cTnI (HR 10.902, 95% 1.279-92.927, p=0.029) and elevated d-dimer (HR 1.103, 95%CI 1.034-1.176, per 1mg/L increase, p=0.003) on admission were independently associated with in-hospital mortality.ConclusionsCardiac injury defined by hs-cTnI elevation and elevated d-dimer on admission were risk factors for in-hospital death, while higher SpO2 could be seen as a protective factor, which could help clinicians to identify patients with adverse outcome at the early stage of COVID-19.

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Clinical Characteristics on Admission Predict In-Hospital Fatal Outcome in Patients Aged ≥75 Years with novel coronavirus disease (COVID-19): A Retrospective Cohort Study

10.21203/rs.3.rs-36077/v3 ◽

2020 ◽

Author(s):

Zhihua Yu ◽

Yuhe Ke ◽

Jiang Xie ◽

Hao Yu ◽

Wei Zhu ◽

...

Keyword(s):

Risk Factors ◽

Body Temperature ◽

Clinical Characteristics ◽

Troponin I ◽

Fatal Outcome ◽

High Sensitivity ◽

Lactic Dehydrogenase ◽

Hospital Death ◽

Laboratory Findings ◽

Novel Coronavirus

Abstract Background：Novel coronavirus disease（COVID-19）has become a worldwide pandemic and precise fatality data by age group are needed urgently. This study to delineate the clinical characteristics and outcome of COVID-19 patients aged ≥75 years and identify the risk factors of in-hospital death.Methods：A total of 141 consecutive patients aged ≥75 years who were admitted to the hospital between 12th and 19th February 2020. In-hospital death, clinical characteristics and laboratory findings on admission were obtained from medical records. The final follow-up observation was 31st March 2020.Results：The median age was 81 years (84 female, 59.6%). Thirty-eight (27%) patients were classified as severe or critical cases. 18 (12.8%) patients had died in hospital and the remaining 123 were discharged. Patients who died were more likely to present with fever (38.9% vs. 7.3%); low percutaneous oxygen saturation(SpO2) (55.6% vs. 7.3%); reduced lymphocytes (72.2% vs. 35.8%) and platelets (27.8% vs. 4.1%); and increased D-dimer (94.4% vs. 42.3%), creatinine (50.0% vs. 22.0%), lactic dehydrogenase (LDH) (77.8% vs. 30.1%), high sensitivity troponin I (hs-TnI) (72.2% vs. 14.6%), and N-terminal pro-brain natriuretic peptide (NT-proBNP) (72.2% vs. 6.5%; all P<0.05) than patients who recovered. Male sex (odds ratio [OR]=13.1, 95% confidence interval[CI] 1.1 to 160.1, P=0.044), body temperature >37.3°C (OR=80.5, 95% CI 4.6 to 1407.6, P=0.003), SpO2≤90% (OR=70.1, 95% CI 4.6 to 1060.4, P=0.002), and NT-proBNP>1800ng/L (OR=273.5, 95% CI 14.7 to 5104.8, P<0.0001) were independent risk factors of in-hospital death. Conclusions：In-hospital fatality among COVID-19 patients can be estimated by sex and on-admission measurements of body temperature, SpO2, and NT-proBNP.

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Abstract 13093: Clinical Features and Prognosis of Acute Cardiac Injury in Hospitalized Patients With Covid-19: A Retrospective Cohort Study

Circulation ◽

10.1161/circ.142.suppl_3.13093 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Mingxing XIE ◽

Li Zhang ◽

yanting zhang ◽

Wei Sun ◽

CHUN WU ◽

...

Keyword(s):

Hospital Mortality ◽

Proportional Hazards ◽

Troponin I ◽

Clinical Laboratory ◽

Invasive Mechanical Ventilation ◽

Cardiac Injury ◽

High Sensitivity ◽

Final Analysis ◽

Cox Proportional Hazards ◽

Hospitalized Patients

Aims: The fatalities case due to coronavirus disease 2019 (COVID-19) is escalating. However, information on critical complications in hospitalized patients of COVID-19 is scant. We aimed to explore the prevalence of acute cardiac injury and its association with in-hospital mortality in COVID-19 patients. Methods: This retrospective study analyzed COVID-19 patients in Union Hospital (Wuhan, China) from Jan 24 to March 18, 2020. Clinical outcomes (discharge, or death) were monitored to April 9, 2020, the latest date of follow-up. Demographic, clinical, laboratory, echocardiographic data, treatment and prognosis were analyzed. Results: A total of 235 COVID-19 patients were included in the final analysis. Their median age was 66 years (interquartile range 57 - 73), and 131 (55.7%) were men. 98 (41.7%) patients were diagnosed with acute cardiac injury, of whom 60 (61.2%) died. There were more comorbidities in those who with acute cardiac injury than those without. A higher proportion of patients with acute cardiac injury received glucocorticoid therapy (68.0% vs 37.0%; P < 0.001), immunoglobulin (53.1% vs 30.1%; P < 0.001) and invasive mechanical ventilation (40.8% vs 6.6%; P < 0.001) than those without. The percentage of patients who were admitted to intensive care unit (39.8 % vs 8.0%; P < 0.001) or died during hospitalization (61.2% vs 8.0%, P < 0.001) were also higher in those with acute cardiac injury. Plasma high-sensitivity troponin I level correlated significantly with plasma interleukin -6, procalcitonin and C-reactive protein levels in COVID-19 patients. Echocardiography showed that cardiac function was attenuated in acute cardiac injury patients. Multivariable Cox proportional hazards regression analysis showed acute cardiac injury was an independent risk factor for higher in-hospital mortality in COVID-19 patients (HR, 3.393; 95% CI, 1.647- 6.987, P <0.001). Conclusions: Acute cardiac injury is a common condition and may be related to inflammatory response in COVID-19 patients. In addition, our study highlights an association between acute cardiac injury and a higher risk of in-hospital mortality. It is suggested that clinicians should be alert to acute cardiac injury in COVID-19 patients and take prompt treatments to improve outcomes.

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Clinical Characteristics on Admission Predict In-Hospital Fatal Outcome in Patients Aged ≥75 Years with novel coronavirus disease (COVID-19) :A Retrospective Cohort Study

10.21203/rs.3.rs-36077/v1 ◽

2020 ◽

Author(s):

Zhihua Yu ◽

Yuhe Ke ◽

Jiang Xie ◽

Hao Yu ◽

Wei Zhu ◽

...

Keyword(s):

Risk Factors ◽

Body Temperature ◽

Clinical Characteristics ◽

Troponin I ◽

Fatal Outcome ◽

High Sensitivity ◽

Lactic Dehydrogenase ◽

Hospital Death ◽

Laboratory Findings ◽

Novel Coronavirus

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Prognostic significance of N-Terminal Pro-BNP in patients with COVID-19 pneumonia without previous history of heart failure

European Heart Journal ◽

10.1093/eurheartj/ehab724.0866 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

M Selcuk ◽

M Keskin ◽

T Cinar ◽

N Gunay ◽

S Dogan ◽

...

Keyword(s):

Heart Failure ◽

Hospital Mortality ◽

Troponin I ◽

Prognostic Significance ◽

Multivariable Analysis ◽

Previous History ◽

Hospital Death ◽

Funding Sources ◽

Elevated Glucose ◽

Artery Disease

Abstract Introduction The objective of the present research was to evaluate the possible association between the N-terminal pro-brain type natriuretic peptide (NT-proBNP) levels and in-hospital mortality in coronavirus disease 2019 (COVID-19) pneumonia patients who did not have pre-existing heart failure (HF). Methods A total of 137 consecutive patients without pre-existing HF and hospitalized due to COVID-19 pneumonia were enrolled into the current research. The main outcome of the research was the in-hospital death. The independent parameters linked with the in-hospital death were determined by multivariable analysis. Results A total of 26 deaths with an in-hospital mortality rate of 18.9% was noted. Those who died were older with an increased frequency of co-morbidities such as hypertension, chronic kidney disease, coronary artery disease, stroke and dementia. They had also increased white blood cell (WBC) counts and had elevated glucose, creatinine, troponin I, and NT-pro-BNP levels but had decreased levels of hemoglobin. By multivariable analysis; age, NT-pro-BNP, WBC, troponin I, and creatinine levels were independently linked with the in-hospital mortality. After ROC evaluation, the ideal value of the NT-pro-BNP to predict the in-hospital mortality was found as 260 ng/L reflecting a sensitivity of 82% and a specificity of 93% (AUC:0.86; 95% CI: 0.76–0.97). Conclusion The current research clearly shows that the NT-proBNP levels are independently linked with the in-hospital mortality rates in subjects with COVID-19 pneumonia and without HF. Thus, we believe that this biomarker can be used as a valuable prognostic parameter in such cases. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

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Prognostic significance of N-Terminal Pro-BNP in patients with COVID-19 pneumonia without previous history of heart failure

Journal of Cardiovascular and Thoracic Research ◽

10.34172/jcvtr.2021.26 ◽

2021 ◽

Vol 13 (2) ◽

pp. 141-145

Author(s):

Murat Selçuk ◽

Muhammed Keskin ◽

Tufan Çınar ◽

Nuran Günay ◽

Selami Doğan ◽

...

Keyword(s):

Heart Failure ◽

Hospital Mortality ◽

Troponin I ◽

Prognostic Significance ◽

Multivariable Analysis ◽

Previous History ◽

Hospital Death ◽

Elevated Glucose ◽

History Of ◽

Artery Disease

Introduction:The objective of the present research was to evaluate the possible association between the N-terminal pro-brain type natriuretic peptide (NT-proBNP) levels and in-hospital mortality in coronavirus disease 2019 (COVID-19) pneumonia patients who did not have pre-existing heart failure (HF). Methods:A total of 137 consecutive patients without pre-existing HF and hospitalized due to COVID-19 pneumonia were enrolled into the current research. The main outcome of the research was the in-hospital death. The independent parameters linked with the in-hospital death were determined by multivariable analysis. Results: A total of 26 deaths with an in-hospital mortality rate of 18.9% was noted. Those who died were older with an increased frequency of co-morbidities such as hypertension, chronic kidney disease, coronary artery disease, stroke and dementia. They had also increased white blood cell (WBC) counts and had elevated glucose, creatinine, troponin I, and NT-pro-BNP levels but had decreased levels of hemoglobin. By multivariable analysis; age, NT-pro-BNP, WBC, troponin I, and creatinine levels were independently linked with the in-hospital mortality. After ROC evaluation, the ideal value of the NT-pro-BNP to predict the in-hospital mortality was found as 260 ng/L reflecting a sensitivity of 82% and a specificity of 93% (AUC:0.86; 95%CI:0.76-0.97). Conclusion: The current research clearly shows that the NT-proBNP levels are independently linked with the in-hospital mortality rates in subjects with COVID-19 pneumonia and without HF. Thus, we believe that this biomarker can be used as a valuable prognostic parameter in such cases.

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Clinical characteristics on admission predict in-hospital fatal outcome in patients aged ≥75 years with novel coronavirus disease (COVID-19): a retrospective cohort study

BMC Geriatrics ◽

10.1186/s12877-020-01921-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Zhihua Yu ◽

Yuhe Ke ◽

Jiang Xie ◽

Hao Yu ◽

Wei Zhu ◽

...

Keyword(s):

Risk Factors ◽

Body Temperature ◽

Clinical Characteristics ◽

Troponin I ◽

Fatal Outcome ◽

High Sensitivity ◽

Lactic Dehydrogenase ◽

Hospital Death ◽

Laboratory Findings ◽

Novel Coronavirus

Abstract Background Novel coronavirus disease 2019 (COVID-19) has become a worldwide pandemic and precise fatality data by age group is needed urgently. This study to delineate the clinical characteristics and outcome of COVID-19 patients aged ≥75 years and identify the risk factors of in-hospital death. Methods A total of 141 consecutive patients aged ≥75 years who were admitted to the hospital between 12th and 19th February 2020. In-hospital death, clinical characteristics and laboratory findings on admission were obtained from medical records. The final follow-up observation was on the 31st March 2020. Results The median age was 81 years (84 female, 59.6%). Thirty-eight (27%) patients were classified as severe or critical cases. 18 (12.8%) patients had died in hospital and the remaining 123 were discharged. Patients who died were more likely to present with fever (38.9% vs. 7.3%); low percutaneous oxygen saturation (SpO2) (55.6% vs. 7.3%); reduced lymphocytes (72.2% vs. 35.8%) and platelets (27.8% vs. 4.1%); and increased D-dimer (94.4% vs. 42.3%), creatinine (50.0% vs. 22.0%), lactic dehydrogenase (LDH) (77.8% vs. 30.1%), high sensitivity troponin I (hs-TnI) (72.2% vs. 14.6%), and N-terminal pro-brain natriuretic peptide (NT-proBNP) (72.2% vs. 6.5%; all P < 0.05) than patients who recovered. Male sex (odds ratio [OR] = 13.1, 95% confidence interval [CI] 1.1 to 160.1, P = 0.044), body temperature > 37.3 °C (OR = 80.5, 95% CI 4.6 to 1407.6, P = 0.003), SpO2 ≤ 90% (OR = 70.1, 95% CI 4.6 to 1060.4, P = 0.002), and NT-proBNP> 1800 ng/L (OR = 273.5, 95% CI 14.7 to 5104.8, P < 0.0001) were independent risk factors of in-hospital death. Conclusions In-hospital fatality among elderly COVID-19 patients can be estimated by sex and on-admission measurements of body temperature, SpO2, and NT-proBNP.

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Abstract 12810: Cardiac Injury and Outcomes of Patients With Covid-19 in New York City

Circulation ◽

10.1161/circ.142.suppl_3.12810 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Toshiki Kuno ◽

Tetsuro Maeda ◽

Reiichiro Obata ◽

Dahlia Rizk

Keyword(s):

New York ◽

Chest Pain ◽

Hospital Mortality ◽

Troponin I ◽

Cardiac Injury ◽

Group Versus ◽

Multivariate Logistic Regression Model ◽

Hospital Death ◽

Elevated Troponin ◽

Injury Group

Background: Prior studies demonstrated COVID-19 patients with elevated troponin were associated with increased in-hospital mortality, however only 27% of patients with cardiac injury were assessed with an electrocardiogram (ECG). The aim of this study was to investigate the association of cardiac injury and ECG abnormality, as well as in-hospital mortality. Methods: We conducted aretrospective cohort study of 224 consecutively admitted patients with confirmed COVID-19 who needed hospitalization between March 13 and March 31, 2020. Those patients with troponin I measurement (N=181) were divided into patients who had elevated troponin I (cardiac injury group), and those who did not (no cardiac injury group). Results: The mean age was 64.0±16.6 and 55.8% were male. The cardiac injury group was more likely to be older, have coronary artery disease, prior atrial fibrillation, as well as congestive heart failure compared to the no cardiac injury group (all P<0.05). Notably, both groups had non-significantly different, relatively low rates of chest pain (cardiac injury group versus no cardiac injury group: 17.0% versus 22.5%, P=0.92). The cardiac injury group had a significantly higher value of brain natriuretic peptide, procalcitonin, interleukin-6 and d-dimer (all P<0.05). Moreover, the cardiac injury group had a relatively low proportion of ECG abnormalities such as T wave inversion (13.2%) and ST depression (1.9%). Cardiac injury group had significantly higher in-hospital mortality than no cardiac injury group (42.3% versus 12.6%, P<0.001). With a multivariate logistic regression model, age (odds ratio (OR) [95% confidential interval (CI)]: 1.033 [1.002-1.065], P=0.034), cardiac injury (3.25 [1.40-7.54], P=0.006), were significant predictors to estimate in-hospital death. Conclusion: COVID-19 patients with elevated troponin had relatively low proportion of chest pain and ECG abnormality. Cardiac injury was associated as an independent predictor to estimate in-hospital death.

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Abstract 16970: Prognostic Utility of High-Sensitivity Troponin I Among Hospitalized COVID-19 Positive Patients in Michigan - A Retrospective Analysis

Circulation ◽

10.1161/circ.142.suppl_3.16970 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Ahmed M Altibi ◽

Radhika Sheth ◽

Allison LeDuc ◽

Lama Al Jebbawi ◽

Ahmad Masri ◽

...

Keyword(s):

Retrospective Analysis ◽

Troponin I ◽

Cardiac Injury ◽

High Sensitivity ◽

Hospital Death ◽

P Value ◽

Elevated Troponin ◽

High Sensitivity Troponin ◽

Kaplan Meier ◽

Prognostic Utility

Introduction: Cardiac injury, evidenced by elevated troponin levels, had been proposed as a prognostic marker in COVID-19 patients. Hypothesis: We conducted a retrospective analysis to investigate whether high-sensitivity troponin I (hs-TNI) predicts mortality in hospitalized COVID-19 patients. Methods: Medical records for all COVID-19 positive patients hospitalized between March 1 and May 10, 2020 were reviewed retrospectively (n= 708). Patients with no available hs-TNI data (n=22) were excluded. Elevated hs-TNI was defined as values >18 ng/L. Multivariate logistic regression and Cox proportional-hazard model were used to investigate association between hs-TNI and in-hospital and 30-day mortality. Adjustment in both models was for age, gender, and race. Kaplan-Meier curve was plotted to compare mortality in patients with and without cardiac injury. Results: In 684 included patients, mean age was 66.9±15.6, 57.6% were males, and 47.7% were Caucasians. Prevalence of comorbidities: hypertension 74.3%, dyslipidemia 57.8%, type 2 diabetes 33.9%, coronary artery disease 19.6%, prior myocardial infarction 9.2%, and heart failure 16.2%. hs-TNI was elevated in 36.6% of included patients. 30-day mortality was higher in patients with elevated hs-TIN (46.8% vs. 14.3%). Unadjusted OR of in-hospital death was 5.0 (95% CI: 3.36-7.31, p-value <0.001) and adjusted OR was 2.97 (95% CI: 1.93-4.55, p-value <0.001). Unadjusted HR of 30-day mortality was 4.1 (95% CI 3.0-5.6, p-value <0.001), and adjusted HR was 2.10 (95% CI: 1.49-2.95, p-value <0.001). Conclusions: Elevated troponin levels in hospitalized COVID-19 patients is associated with significant increase in risk of in-hospital and 30-day mortality.

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Myocardial injury in critically ill patients with community-acquired pneumonia

10.1101/155747 ◽

2017 ◽

Author(s):

Jos. F. Frencken ◽

Lottie van Baal ◽

Teus H. Kappen ◽

Dirk W. Donker ◽

Janneke Horn ◽

...

Keyword(s):

Risk Factors ◽

Cardiac Troponin ◽

Myocardial Injury ◽

Troponin I ◽

Temporal Dynamics ◽

Cardiac Injury ◽

High Sensitivity ◽

Community Acquired Pneumonia ◽

Troponin Release ◽

Artery Disease

AbstractBackgroundMyocardial injury, as reflected by elevated cardiac troponin levels in plasma, is common in patients with community-acquired pneumonia (CAP), but its temporal dynamics and etiology remain unknown. Our aim was to determine the incidence of troponin release in patients with CAP and identify risk factors which may point to underlying etiologic mechanisms.MethodsWe included consecutive patients admitted with severe CAP to two intensive care units in the Netherlands between 2011 and 2015. High-sensitivity cardiac troponin I was measured daily during the first week. We used multivariable linear regression to identify variables associated with troponin release on admission, and mixed-effects regression to model the daily rise and fall of troponin levels over time.ResultsAmong 200 eligible patients, 179 were included, yielding 792 observation days. A total of 152 (85%) patients developed raised troponin levels >26 ng/L. Baseline factors independently associated with troponin release included coronary artery disease (160% increase, 95% CI 7–529), smoking (304% increase, 95% CI 59-924), and higher APACHE IV score (2% increase, 95% CI 0.7-3.3), whereasStaphylococcus aureusas a causative pathogen was protective (67% reduction, 95% CI 9-88). Time-dependent risk factors independently associated with daily increase in troponin concentrations included reduced platelet count (1.7% increase, 95% CI 0.1-3.4), tachycardia (1.6% increase, 95% CI 0.3-3), hypotension (5.1% increase, 95% CI 1-9.4) and dobutamine use (38.4% increase 95% CI 8.8-76).ConclusionsCardiac injury develops in a majority of patients with severe CAP. Myocardial oxygen supply-demand mismatch and activated coagulation are potential causes of this injury.

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