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 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 Is High Sensitive-Troponin I A Reliable Biomarker For Cardiac Injury In Methadone Toxicity? A Prospective Cross-Sectional Study

2021 ◽  
Author(s):  
Hasan Shemirani ◽  
Masoumeh Sadeghi ◽  
Azadeh Davoudian Dehkordi ◽  
Farzad Gheshlaghi
Keyword(s):  
Troponin I ◽  
Cardiac Injury ◽  
High Sensitivity ◽  
Cross Sectional Study ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cross Sectional ◽  
Ventricular Ejection Fraction ◽  
High Sensitivity Troponin ◽  
High Sensitive Troponin

Abstract Background: Methadone is a synthetic opioid mostly used for detoxification therapy, as its use increases; the possibility for methadone-induced cardiotoxicity may rise. The aim of this study was to determine the association of high-sensitivity troponin I levels as a predictor of cardiac injury in methadone toxicity.Methods: Sixty methadone toxicity patients included in this prospective cross-sectional study from October 2018-November 2020. High-sensitivity troponin I level and electrocardiogram were assessed in patients at admission. All patients underwent echocardiography at admission and 30 days later and compared this findings between two groups based on high-sensitivity troponin I results.Results: Mean age of the patients was 34.5±11.1 years (males: 66%). Twelve (20%) patients had positive high sensitive-troponin results. Long QT interval and inverted T in precordial leads were mostly observed in individuals with positive high-sensitivity troponin I (75% vs. 35%, P=0.013 and 83% vs. 16%, P<0.001, respectively). Patients with elevated troponin had reduced left ventricular ejection fraction in comparison to normal group during admission (43.1±15.4% vs. 55%, P<0.001) and this left ventricular ejection fraction remained abnormal after 30 days (43.7±21.6%). Patients in positive high-sensitivity troponin I group had higher regional wall motion abnormality frequency both at admission and 30 days later compared to the other group (0 day: 42% vs. 0, P<0.001, 30th days: 25% vs. 4%, P=0.020).Conclusion: Patients with simultaneous methadone toxicity and positive high-sensitivity troponin I had worse cardiac outcomes and this biomarker could be probably used for better implementation of therapeutic interventions and prognosis.

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.

scholarly journals Cardiac Involvement in Recovered Patients From COVID-19: A Preliminary 6-Month Follow-Up Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Xiaoyan Wu ◽  
Ke-Qiong Deng ◽  
Chenze Li ◽  
Zhaoxia Yang ◽  
Huijuan Hu ◽  
...  
Keyword(s):  
Late Gadolinium Enhancement ◽  
Cardiac Involvement ◽  
Troponin I ◽  
Cardiac Injury ◽  
High Sensitivity ◽  
Inflammatory Factor ◽  
Gadolinium Enhancement ◽  
Follow Up Study ◽  
High Sensitivity Troponin

Background: Accumulating evidence has revealed that coronavirus disease 2019 (COVID-19) patients may be complicated with myocardial injury during hospitalization. However, data regarding persistent cardiac involvement in patients who recovered from COVID-19 are limited. Our goal is to further explore the sustained impact of COVID-19 during follow-up, focusing on the cardiac involvement in the recovered patients.Methods: In this prospective observational follow-up study, we enrolled a total of 40 COVID-19 patients (20 with and 20 without cardiac injury during hospitalization) who were discharged from Zhongnan Hospital of Wuhan University for more than 6 months, and 27 patients (13 with and 14 without cardiac injury during hospitalization) were finally included in the analysis. Clinical information including self-reported symptoms, medications, laboratory findings, Short Form 36-item scores, 6-min walk test, clinical events, electrocardiogram assessment, echocardiography measurement, and cardiac magnetic resonance imaging was collected and analyzed.Results: Among 27 patients finally included, none of patients reported any obvious cardiopulmonary symptoms at the 6-month follow-up. There were no statistically significant differences in terms of the quality of life and exercise capacity between the patients with and without cardiac injury. No significant abnormalities were detected in electrocardiogram manifestations in both groups, except for nonspecific ST-T changes, premature beats, sinus tachycardia/bradycardia, PR interval prolongation, and bundle-branch block. All patients showed normal cardiac structure and function, without any statistical differences between patients with and without cardiac injury by echocardiography. Compared with patients without cardiac injury, patients with cardiac injury exhibited a significantly higher positive proportion in late gadolinium enhancement sequences [7/13 (53.8%) vs. 1/14 (7.1%), p = 0.013], accompanied by the elevation of circulating ST2 level [median (interquartile range) = 16.6 (12.1, 22.5) vs. 12.5 (9.5, 16.7); p = 0.044]. Patients with cardiac injury presented higher levels of aspartate aminotransferase, creatinine, high-sensitivity troponin I, lactate dehydrogenase, and N-terminal pro–B-type natriuretic peptide than those without cardiac injury, although these indexes were within the normal range for all recovered patients at the 6-month follow-up. Among patients with cardiac injury, patients with positive late gadolinium enhancement presented higher cardiac biomarker (high-sensitivity troponin I) and inflammatory factor (high-sensitivity C-reactive protein) on admission than the late gadolinium enhancement–negative subgroup.Conclusions: Our preliminary 6-month follow-up study with a limited number of patients revealed persistent cardiac involvement in 29.6% (8/27) of recovered patients from COVID-19 after discharge. Patients with cardiac injury during hospitalization were more prone to develop cardiac fibrosis during their recovery. Among patients with cardiac injury, those with relatively higher cardiac biomarkers and inflammatory factors on admission appeared more likely to have cardiac involvement in the convalescence phase.

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 Laboratory predictors of death from coronavirus disease 2019 (COVID-19) in the area of Valcamonica, Italy

2020 ◽  
Vol 58 (7) ◽  
pp. 1100-1105 ◽  
Author(s):  
Graziella Bonetti ◽  
Filippo Manelli ◽  
Andrea Patroni ◽  
Alessandra Bettinardi ◽  
Gianluca Borrelli ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Clinical Decision Making ◽  
Troponin I ◽  
Laboratory Data ◽  
High Sensitivity ◽  
Clinical Decision ◽  
International Normalized Ratio ◽  
Serum Glucose ◽  
Hospital Death ◽  
Laboratory Findings

AbstractBackgroundComprehensive information has been published on laboratory tests which may predict worse outcome in Asian populations with coronavirus disease 2019 (COVID-19). The aim of this study is to describe laboratory findings in a group of Italian COVID-19 patients in the area of Valcamonica, and correlate abnormalities with disease severity.MethodsThe final study population consisted of 144 patients diagnosed with COVID-19 (70 who died during hospital stay and 74 who survived and could be discharged) between March 1 and 30, 2020, in Valcamonica Hospital. Demographical, clinical and laboratory data were collected upon hospital admission and were then correlated with outcome (i.e. in-hospital death vs. discharge).ResultsCompared to patients who could be finally discharged, those who died during hospital stay displayed significantly higher values of serum glucose, aspartate aminotransferase (AST), creatine kinase (CK), lactate dehydrogenase (LDH), urea, creatinine, high-sensitivity cardiac troponin I (hscTnI), prothrombin time/international normalized ratio (PT/INR), activated partial thromboplastin time (APTT), D-dimer, C reactive protein (CRP), ferritin and leukocytes (especially neutrophils), whilst values of albumin, hemoglobin and lymphocytes were significantly decreased. In multiple regression analysis, LDH, CRP, neutrophils, lymphocytes, albumin, APTT and age remained significant predictors of in-hospital death. A regression model incorporating these variables explained 80% of overall variance of in-hospital death.ConclusionsThe most important laboratory abnormalities described here in a subset of European COVID-19 patients residing in Valcamonica are highly predictive of in-hospital death and may be useful for guiding risk assessment and clinical decision-making.

scholarly journals Adding stress biomarkers to high sensitivity troponin measurements increases precision and efficacy of rapid rule out protocols for NSTEMI

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I Restan ◽  
O.T Steiro ◽  
H.L Tjora ◽  
J Langoergen ◽  
T Omland ◽  
...  
Keyword(s):  
Chest Pain ◽  
Acute Chest Pain ◽  
High Sensitivity ◽  
Final Diagnosis ◽  
Public Institution ◽  
P Value ◽  
Funding Source ◽  
University Hospitals ◽  
High Sensitivity Troponin ◽  
Rule Out

Abstract Background NSTEMI may be ruled out in patients presenting with acute chest pain based on low baseline high sensitivity troponin (cTn) at admission. This procedure is limited by a low expected frequency of ruled out non-cardiac chest pain (NCCP) patients. Purpose To investigate if stress-induced biomarkers (glucose or copeptin) combined with cTn can increase the rate of NCCP ruled out without an unacceptable increase in incorrectly ruled out NSTEMI. Method 971 patients with suspected NSTE-ACS were included. Final diagnosis was adjudicated by two independent cardiologists using clinical data including routine cTnT. Additionally, baseline cTnI, cTnI from Singulex Clarity System (cTnI(sgx)), copeptin and glucose were measured. Diagnostic performance to rule out NSTEMI was compared between the ESC rule out algorithms for cTnT and cTnI(Abbott), a local cTnI(sgx) algorithm and different combinations of cTn with copeptin or glucose Results Median age 61 years, 60% male. 13% had NSTEMI, 12% had UAP and 60% NCCP. Distribution of copeptin and glucose concentrations (NSTEMI and NCCP) is shown in figure 1. Copeptin and cTnT produces an algorithm with lower miss rate for NSTEMI, increased rule out rate for NCCP and significantly higher AUC (DeLong test, p value &lt;0.001) compared to the ESC algorithm (Table 1). cTnI(sgx) and copeptin showed higher rule out for NCCP and higher AUC (p value &lt;0.001), however an increased rule out rate for NSTEMIs. Combining cTnI(Abbott) and glucose gave a similar miss rate for NSTEMI as ESC, but increased rule out rate for NCCP and higher AUC (p value &lt;0.001). Conclusion Combining cTnT or cTnI(sgx) with copeptin; or cTnI with glucose, improves diagnostic precision and efficacy of rule out protocols for NSTEMI in patients presenting with acute chest pain. Figure 1 Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Western Norway Regional Health Authority; Haukeland and Stavanger University Hospitals

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.

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