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

Circulation ◽  
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.

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

2020 ◽  
Author(s):  
Alberto Cipriani ◽  
Federico Capone ◽  
Filippo Donato ◽  
Leonardo Molinari ◽  
Davide Ceccato ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Mediation Analysis ◽  
Troponin I ◽  
Cardiac Injury ◽  
High Sensitivity ◽  
Lactic Dehydrogenase ◽  
Hospital Death ◽  
Relative Role ◽  
Chronic Coronary Artery Disease ◽  
Artery Disease

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.

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

2020 ◽  
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.

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

Circulation ◽  
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.

scholarly journals Key factors leading to fatal outcomes in COVID-19 patients with cardiac injury

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yiyu He ◽  
Xiaoxin Zheng ◽  
Xiaoyan Li ◽  
Xuejun Jiang
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
High Risk ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Troponin I ◽  
Cardiac Injury ◽  
Advanced Age ◽  
Hospital Death ◽  
Key Factors

AbstractCardiac injury among patients with COVID-19 has been reported and is associated with a high risk of mortality, but cardiac injury may not be the leading factor related to death. The factors related to poor prognosis among COVID-19 patients with myocardial injury are still unclear. This study aimed to explore the potential key factors leading to in-hospital death among COVID-19 patients with cardiac injury. This retrospective single-center study was conducted at Renmin Hospital of Wuhan University, from January 20, 2020 to April 10, 2020, in Wuhan, China. All inpatients with confirmed COVID-19 (≥ 18 years old) and cardiac injury who had died or were discharged by April 10, 2020 were included. Demographic data and clinical and laboratory findings were collected and compared between survivors and nonsurvivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with mortality in COVID-19 patients with cardiac injury. A total of 173 COVID-19 patients with cardiac injury were included in this study, 86 were discharged and 87 died in the hospital. Multivariable regression showed increased odds of in-hospital death were associated with advanced age (odds ratio 1.12, 95% CI 1.05–1.18, per year increase; p < 0.001), coagulopathy (2.54, 1.26–5.12; p = 0·009), acute respiratory distress syndrome (16.56, 6.66–41.2; p < 0.001), and elevated hypersensitive troponin I (4.54, 1.79–11.48; p = 0.001). A high risk of in-hospital death was observed among COVID-19 patients with cardiac injury in this study. The factors related to death include advanced age, coagulopathy, acute respiratory distress syndrome and elevated levels of hypersensitive troponin I.

scholarly journals Troponin: the biomarker of choice for the detection of cardiac injury

2005 ◽  
pp. 1191-1202
Author(s):  
Luciano Babuin ◽  
Allan S. Jaffe
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Acute Myocardial Infarction ◽  
Troponin I ◽  
Cardiac Injury ◽  
Transaminase Activity ◽  
Elevated Troponin ◽  
Critical Issues ◽  
European Society Of Cardiology

It has been known for 50 years that transaminase activity increases in patients with acute myocardial infarction. With the development of creatine kinase (CK), biomarkers of cardiac injury began to take a major role in the diagnosis and management of patients with acute cardiovascular disease. In 2000 the European Society of Cardiology and the American College of Cardiology recognized the pivotal role of biomarkers and made elevations in their levels the “cornerstone” of diagnosis of acute myocardial infarction. At that time, they also acknowledged that cardiac troponin I and T had supplanted CK-MB as the analytes of choice for diagnosis. In this review, we discuss the science underlying the use of troponin biomarkers, how to interpret troponin values properly and how to apply these measurements to patients who present with possible cardiovascular disease. Troponin is the biomarker of choice for the detection of cardiac injury. To use it properly, one must understand how sensitive the specific assay being used is for detecting cardiac injury, the fact that elevated troponin levels are highly specific for cardiac injury and some critical issues related to the basic science of the protein and its measurement. In this article, we review the biology of troponin, characteristics of assays that measure serum troponin levels and how to apply these measurements to patients who present with possible cardiovascular disease. We also discuss other clinical situations in which troponin levels may be elevated.

Abstract 17331: Elevated Troponin Levels Predict Major Adverse Cardiovascular Outcomes and Mortality in COVID-19 Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Chirag Patel ◽  
Farukh Ikram ◽  
Nicholas Nguyen ◽  
Hao Nguyen ◽  
Priyanka Acharya ◽  
...  
Keyword(s):  
Chest Pain ◽  
Cardiovascular Events ◽  
Troponin I ◽  
Cardiovascular Complications ◽  
Hospitalized Patients ◽  
Cardiac Biomarkers ◽  
Major Adverse Cardiovascular Events ◽  
Care Hospital ◽  
Elevated Troponin ◽  
Chi Square

Introduction: Measurement of cardiac biomarkers such as troponin-I (TnI) are useful in assessing for the presence of cardiovascular events. Chest pain is often not a presenting complaint of COVID-19 patients, yet there have been many cases of patients experiencing possible cardiovascular complications. We sought to examine the value of elevated TnI in predicting the occurrence of major adverse cardiovascular events (MACE) and mortality in COVID-19 patients Methods: A retrospective review was performed on 225 hospitalized patients that tested positive for COVID-19 between March and May 2020 at our quaternary care hospital. Baseline characteristics and clinical outcomes of their disease course were identified. During the chart review, we documented the admission and peak TnI levels available in the medical record, and noted the occurrence of MACE (a composite of myocardial infarction, stroke, pulmonary embolism, deep venous thrombosis, or shock requiring vasopressor support) or death. Data were analyzed using Pearson’s chi square test and logistic regression to adjust for age. Results: Of the 225 hospitalized patients, only 31(14.83%) complained of chest pain on admission. Among patients with elevated TnI, 49.15% had MACE/ Mortality, compared to 21% with non-elevated TnI. Patients with elevated TnI were nearly 4 times more likely to have MACE/Mortality than patients with non-elevated TnI (p = 0.0001; OR = 3.97; 95% CI [1.88, 8.41]). They were also 3.63 times more likely to have MACE alone (p < 0.0001; OR = 3.63; 95% CI [1.70, 7.79]). Median peak TnI values were higher in patients who had a MACE compared to those who did not (0.0275 ng/mL [IQR 0.012-0.152] vs 0.012 ng/mL [IQR 0.012-0.152], p <0.05). For every one-unit increase in peak TnI levels, the age-adjusted odds of having MACE increased by a factor of 4468.37 (95% CI [9.07 2200316.00]; p = 0.008). Conclusions: Based on our data, elevated troponin-I levels predict the occurrence of MACE in patients who are hospitalized with COVID-19. Furthermore, there is an association between elevated troponin-I and eventual MACE, mortality, or both. This suggests that checking troponin-I levels in COVID-19 patients holds prognostic value, irrespective of the presence of chest pain as a presenting complaint.

Pre-existing opioid use disorder and postoperative outcomes after appendectomy or cholecystectomy: A multi-state analysis, 2007-2014

2019 ◽  
Vol 15 (3) ◽  
pp. 235-251
Author(s):  
Alina Boltunova, MD ◽  
Robert S. White, MD, MS ◽  
Selaiman Noori, MD ◽  
Stephanie A. Chen, BA ◽  
Licia K. Gaber-Baylis, BA ◽  
...  
Keyword(s):  
New York ◽  
Postoperative Complications ◽  
Hospital Mortality ◽  
Hospital Readmission ◽  
Opioid Use Disorder ◽  
Postoperative Outcomes ◽  
Hospital Length Of Stay ◽  
Hospital Death ◽  
Surgical Patient ◽  
Opioid Use

Introduction and objectives: Opioid use disorder has become increasingly prevalent in recent years. Previous studies have shown that patients with opioid use disorder undergoing orthopedic, elective abdominopelvic, and cardiac procedures have poorer postoperative outcomes. The aim of this study was to examine the effect of pre-existing opioid use disorder on postoperative outcomes including in-hospital mortality, hospital length of stay (LOS), hospital readmission, and postoperative complications in patients undergoing appendectomy or cholecystectomy.Methods: The authors used administrative data from the State Inpatient Databases of the Healthcare Cost and Utilization Project for the years 2007-2014 from California, Florida, Kentucky, Maryland, and New York. The authors compared unadjusted rates of in-hospital mortality, postoperative complications, LOS, and 30-day and 90-day readmission status. The authors calculated the adjusted odds ratio (OR) for their outcomes using logistic regression models.Results: In all, 488,981 appendectomy patients and 790,491 cholecystectomy patients aged ≥ 18 years were included in the analysis. Appendectomy (OR 2.26) but not cholecystectomy patients with opioid use disorder had statistically significant adjusted odds of in-hospital death. Patients with opioid use disorder (overall reported, and by each procedure separately) had higher adjusted odds of postoperative complication (OR 1.46), 30-day readmission (OR 1.80), 90-day readmission (OR 1.98), and longer LOS (OR 1.37).Conclusions: The authors found higher unadjusted rates and adjusted ORs of in-patient mortality, hospital readmission, and postoperative complications in patients with opioid use disorder undergoing common abdominal surgeries. The authors’ study shows that opioid use disorder is a risk factor for poorer postoperative outcomes in this surgical patient population.

scholarly journals The value of indicators characterizing the state of the cardiovascular system in assessing the hospital prognosis of COVID-19 patients

Kardiologiia ◽  
2021 ◽  
Vol 61 (10) ◽  
pp. 26-35
Author(s):  
I. V. Kovtyukh ◽  
G. E. Gendlin ◽  
I. G. Nikitin ◽  
A. M. Baymukanov ◽  
A. E. Nikitin ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Troponin I ◽  
Fatal Outcome ◽  
Left Ventricular ◽  
Hospital Death ◽  
The Novel ◽  
Blood Oxygen Saturation ◽  
Coronavirus Infection ◽  
Novel Coronavirus ◽  
High Degree

Background     Heart damage is one of complications of the novel coronavirus infection. Searching for available predictors for in-hospital death and survival that determine the tactic of managing patients with COVID-19, is a challenge of the present time.Aim      To determine the role echocardiographic (EchoCG) parameters in evaluation of the in-hospital prognosis for patients with the novel coronavirus infection, COVID-19.Material and methods  The study included 158 patients admitted for COVID-19. EchoCG was performed for all patients. The role of left ventricular (LV) ejection fraction (EF) was analyzed in various age groups. EchoCG data were compared with the clinical picture, including the severity of respiratory failure (RF), blood oxygen saturation (SрО2), data of computed tomography (CT) of the lungs, and blood concentration of troponin. Comorbidity was analyzed, and the highest significance of individual pathologies was determined.Results LV EF ≤40 % determined the worst prognosis of patients with COVID-19 (p<0.0001), including the age group older than 70 years (р=0.013). LV EF did not correlate with the degree of lung tissue damage determined by CT upon admission (р=0.54) and over time (р=0.23). The indexes that determined an adverse in-hospital prognosis to a considerable degree were pericardial effusion (p<0.0001) and pulmonary hypertension (p<0.0001). RV end-diastolic dimension and LV end-diastolic volume did not determine the in-hospital mortality and survival. Blood serum concentration of troponin I higher than 165.13 µg/l was an important predictor for in-hospital death with a high degree of significance (р<0.0001). Th degree of RF considerably influenced the in-hospital mortality (р<0.0001). RF severity was associated with LV EF (р=0.024). The SpO2 value determined an adverse immediate prognosis with a high degree of significance (р=0.0009). This parameter weakly correlated with LV EF (r=0.26; p=0.0009). Patients who required artificial ventilation (AV) constituted a group with the worst survival rate (р<0.0001). LV EF was associated with a need for AV with a high degree of significance (р=0.0006). Comorbidities, such as chronic kidney disease, postinfarction cardiosclerosis and oncologic diseases, to the greatest extent determined the risk of fatal outcome.Conclusion      EchoCG can be recommended for patients with COVID-19 at the hospital stage to determine the tactics of management and for the in-hospital prognosis.

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

Circulation ◽  
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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