Abstract 17471: Outcome of Acute Myocardial Injury in COVID-19 Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Magdi Zordok ◽  
Muhammad Etiwy ◽  
Shruti Hegde ◽  
Michael Maysky
Keyword(s):  
Myocardial Injury ◽  
Average Length ◽  
Invasive Mechanical Ventilation ◽  
Morbidity And Mortality ◽  
Hospital Death ◽  
Chronic Obstructive ◽  
High Morbidity ◽  
Elevated Troponin ◽  
Obstructive Sleep ◽  
Acute Myocardial Injury

Background: Acute myocardial injury has been reported in approximately 20% of patients with Coronavirus disease 2019 (COVID-19). Little is known about the outcome of this subset of patients. We are testing the hypothesis of higher morbidity and mortality in patients with COVID-19 who have acute myocardial injury. Methods: In this retrospective study, we analyzed data from patients admitted to Steward Healthcare hospitals in Massachusetts between March 22 and April 24, who tested positive for COVID-19 confirmed by serology and found to have elevated troponin levels (>0.01). The sociodemographic information, clinical data, and outcomes of these critically ill patients were retrospectively extracted from the medical records. The primary outcome was in-hospital death. Data were analyzed using JMP statistical analysis software. Results: Two hundred eighty-three COVID-19 positive patients were found to have troponin levels >0.01 on admission. Of these 183 patients (64.6%) were males, 49.1% were Caucasian and 32.1% were African Americans. The mean age of the patients was 70.7 ± 13.8. The prevalence of comorbid conditions was as follows: hypertension, 69.7%; hyperlipidemia, 46.9%; diabetes mellitus, 42.6%; chronic kidney disease, 28.3%; heart failure, 19.3%; atrial fibrillation, 22.1%; coronary artery disease, 17.1%; cerebrovascular accident, 10.2%; obesity, 38%; chronic obstructive pulmonary disease or asthma 20.8%, obstructive sleep apnea, 4.9%. One hundred thirty-seven patients (48.4%) noted to have acute kidney injury on presentation,128 (45.2%) required ICU level of care, 41% required invasive mechanical ventilation for a mean of 10.4 ± 7.9 days, and 38.8% required vasopressors. The average length of stay (LOS) in the medical intensive care unit and the hospital was 11.5 ± 8.3 days and 11.4 ± 9.5 days respectively. The overall in-hospital mortality rate was 45.6%. Conclusion: Patients with COVID-19 and elevated Troponin levels had high morbidity and mortality

scholarly journals Multimorbidity clusters in patients with chronic obstructive airway diseases in the EpiChron Cohort

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jonás Carmona-Pírez ◽  
Beatriz Poblador-Plou ◽  
Ignatios Ioakeim-Skoufa ◽  
Francisca González-Rubio ◽  
Luis Andrés Gimeno-Feliú ◽  
...  
Keyword(s):  
Substance Use ◽  
Chronic Conditions ◽  
Large Scale ◽  
Mental Health Problems ◽  
Epidemiological Studies ◽  
Chronic Obstructive ◽  
High Morbidity ◽  
Airway Diseases ◽  
Obstructive Sleep ◽  
Obstructive Airway Diseases

AbstractChronic obstructive airway diseases such as chronic obstructive pulmonary disease (COPD), asthma, rhinitis, and obstructive sleep apnea (OSA) are amongst the most common treatable and preventable chronic conditions with high morbidity burden and mortality risk. We aimed to explore the existence of multimorbidity clusters in patients with such diseases and to estimate their prevalence and impact on mortality. We conducted an observational retrospective study in the EpiChron Cohort (Aragon, Spain), selecting all patients with a diagnosis of allergic rhinitis, asthma, COPD, and/or OSA. The study population was stratified by age (i.e., 15–44, 45–64, and ≥ 65 years) and gender. We performed cluster analysis, including all chronic conditions recorded in primary care electronic health records and hospital discharge reports. More than 75% of the patients had multimorbidity (co-existence of two or more chronic conditions). We identified associations of dermatologic diseases with musculoskeletal disorders and anxiety, cardiometabolic diseases with mental health problems, and substance use disorders with neurologic diseases and neoplasms, amongst others. The number and complexity of the multimorbidity clusters increased with age in both genders. The cluster with the highest likelihood of mortality was identified in men aged 45 to 64 years and included associations between substance use disorder, neurologic conditions, and cancer. Large-scale epidemiological studies like ours could be useful when planning healthcare interventions targeting patients with chronic obstructive airway diseases and multimorbidity.

scholarly journals Effects of Smoking on Pilots of Bangladesh Air Force in Dhaka Area

2016 ◽  
Vol 12 (1) ◽  
pp. 22-27
Author(s):  
Mohammad Ahmed Ahsan ◽  
Umar Rashed Munir ◽  
Mushtaq Ahmad ◽  
Md Shahidullah
Keyword(s):  
High Altitude ◽  
Air Force ◽  
Night Vision ◽  
Morbidity And Mortality ◽  
Chronic Obstructive ◽  
High Morbidity ◽  
Compensatory Mechanism ◽  
Upper Respiratory Tract ◽  
Physical Deterioration ◽  
Medical Category

Introduction: Smokers have a high morbidity and mortality rate and the causes of excess morbidity and mortality include lung cancer, COPD (Chronic Obstructive Pulmonary Disease) and cor pulmonale. An estimated 100 million people died in the 20th century from tobacco-associated diseases. Smoking also affects the performance and cause physical deterioration of pilots. Objectives: To evaluate the effects of smoking on pilots of Bangladesh Air Force (BAF), Dhaka area. Materials and Methods: This cross sectional study was conducted during the period of January to June 2014 among the available pilots of different age and ranks of 6 flying squadrons of BAF Dhaka area. Data were collected by using a pre-tested semistructured questionnaire distributed among the pilots. Information were also collected from Central Medical Board (CMB), BAF about total number of pilots placed in low medical category and nature of their sickness. Finally chest X-ray and ECG of the pilots were done to find out any respiratory and cardiovascular abnormalities. Data obtained were entered into SPSS version 21.0 for analysis. Results: Total 190 pilots were interviewed and among them, 80(42%) were smokers and 110(58%) were non-smokers. Most of the pilots were within the age group of 26-30 years (30%). Out of 80 smoker, 37(46%) smoked for more than 10 years, rest smoked for 10 years and less. Stress was the most common cause of starting smoking (96.3%). Fifty eight (72.5%) pilots agreed that their stamina and physical efficiency decreased due to smoking, 21 (26.3%) experienced breathlessness at high altitude, 26(32.5%) experienced visual disturbance during night flying. Fifty three (66.3%) pilots complained of occasional episode of palpitation along with increase in pulse rate. Thirty one (39%) experienced occasional headache during high altitude flight, 58(72.5%) had heart burn related to smoking. Thirty eight (47.5%) had occasional bouts of cough with sputum and 40(50%) complained of occasional gum bleeding. These pilots also informed that they reported sick several times for headache, heart burn, cough and URTI (Upper Respiratory Tract Infection) and were unfit for flying duties. During January-June 2014, a total of 10 pilots of BAF Dhaka area were placed in low medical category out of them 6 (60%) pilots had smoking habits and suffered from IHD-4 (Ischemic Heart Disease) and HTN-2 (Hypertension). There was statistically significant association between number of the cigarette smoked, period of smoking and physical deterioration of smoker pilots (P<0.05). Those who smoked more than 10 sticks/day and more than 10 years had moderate to severe physical deterioration. Conclusion: Smoking adversely affects all systems of human body. It impairs altitude tolerance, early induction of hypoxia, impairment of night vision. It affects autonomic systems and thus impairs all compensatory mechanism needed at higher altitudes. Morbidity and mortality related to smoking have linear relation. Pilots must be indoctrinated not to smoke for the sake of their safety flight, own life, their families and the nation. Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 22-27

scholarly journals Acute Myocardial Injury of Patients with Coronavirus Disease 2019

2020 ◽  
Author(s):  
Huayan Xu ◽  
Keke Hou ◽  
Hong Xu ◽  
Zhenlin Li ◽  
Huizhu Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Injury ◽  
Cardiac Injury ◽  
Cardiac Complications ◽  
Chronic Obstructive ◽  
C Reactive Protein ◽  
Obstructive Pulmonary Disease ◽  
Reactive Protein ◽  
Acute Myocardial Injury ◽  
Novel Coronavirus

AbstractBackgroundSince the outbreak of the Coronavirus Disease 2019 (COVID-19) in China, respiratory manifestations of the disease have been observed. However, as a fatal comorbidity, acute myocardial injury (AMI) in COVID-19 patients has not been previously investigated in detail. We investigated the clinical characteristics of COVID-19 patients with AMI and determined the risk factors for AMI in them.MethodsWe analyzed data from 53 consecutive laboratory-confirmed and hospitalized COVID-19 patients (28 men, 25 women; age, 19–81 years). We collected information on epidemiological and demographic characteristics, clinical features, routine laboratory tests (including cardiac injury biomarkers), echocardiography, electrocardiography, imaging findings, management methods, and clinical outcomes.ResultsCardiac complications were found in 42 of the 53 (79.25%) patients: tachycardia (n=15), electrocardiography abnormities (n=11), diastolic dysfunction (n=20), elevated myocardial enzymes (n=30), and AMI (n=6). All the six AMI patients were aged >60 years; five of them had two or more underlying comorbidities (hypertension, diabetes, cardiovascular diseases, and chronic obstructive pulmonary disease). Novel coronavirus pneumonia (NCP) severity was higher in the AMI patients than in patients with non-definite AMI (p<0.001). All the AMI patients required care in intensive care unit; of them, three died, two remain hospitalized. Multivariate analyses showed that C-reactive protein (CRP) levels, NCP severity, and underlying comorbidities were the risk factors for cardiac abnormalities in COVID-19 patients.ConclusionsCardiac complications are common in COVID-19 patients. Elevated CRP levels, underlying comorbidities, and NCP severity are the main risk factors for cardiac complications in COVID-19 patients.

scholarly journals COVID-19 associated chronic ARDS successfully treated with lenzilumab

2020 ◽  
Author(s):  
Juan D Pulido ◽  
Omar Ahmed ◽  
Rida Rasool ◽  
Gabrielle Chappell ◽  
Cameron Durrant ◽  
...  
Keyword(s):  
T Cell ◽  
Supportive Care ◽  
Invasive Mechanical Ventilation ◽  
Drug Application ◽  
Patient Characteristics ◽  
Chronic Obstructive ◽  
Double Blind ◽  
Gm Csf ◽  
Obstructive Sleep ◽  
Single Use

Background:Myeloid hyperinflammation leading to T-cell immune suppression and lymphocytopenia is a hallmark of severe COVID-19. Granulocyte macrophage-colony stimulating factor (GM-CSF) neutralization may prevent myeloid driven T-cell suppression leading to increased lymphocyte counts in patients with COVID-19. Given the dual mechanism of action, lenzilumab (anti-human GM-CSF monoclonal antibody) may reduce myeloid driven hyperinflammation and improve CD8+ antiviral T-cell responses directed at SARS-Cov-2 reducing the morbidity, mortality, need for invasive mechanical ventilation (IMV) and duration of hospitalization.Methods:Hospitalized subject with confirmed COVID-19 pneumonia and established risk factors for poor outcomes was treated in the ICU for 12 weeks using standard supportive care for chronic acute respiratory distress syndrome (ARDS). An emergency single-use investigational new drug application (IND) was approved for lenzilumab 600 mg, administered intravenously every eight hours for a total of three doses. Patient characteristics, clinical and laboratory outcomes, and adverse events were recorded through duration of hospitalization.Results:77-year-old Caucasian male with past medical history of severe chronic obstructive pulmonary disease (COPD) with emphysema, coronary artery disease, type II diabetes, and obstructive sleep apnea admitted to ICU with fever, shortness of breath and confirmed SARS-CoV-2 infection. Patient was treated with standard supportive care including corticosteroids. Over the course of his ICU stay, the patient developed ARDS and on week 13, and after several unsuccessful attempts at oxygen weaning, lenzilumab was administered via emergency single use IND. One-week post lenzulimab therapy, oxygen demands decreased, lymphopenia appeared to improve and sixteen days post lenzulimab therapy, the patient was discharged home on 4L nasal cannula. No infusion-related or systemic side effects were noted.Conclusion:In a case of COVID-19 with multiple co-morbidities, refractory to corticosteroids, and deteriorating for several months, GM-CSF neutralization with lenzilumab appeared to reduce oxygen requirements, improve lymphopenia and accelerate time to recovery/discharge in a COVID-19 subject. A randomized, double-blind, placebo-controlled phase 3 clinical trial is ongoing to validate these findings (NCT04351152).

Thirty-day unplanned readmission in hospitalised asthma patients in the USA

2021 ◽  
pp. postgradmedj-2021-140735
Author(s):  
Neel Patel ◽  
Sandeep Singh ◽  
Rupak Desai ◽  
Aakash Desai ◽  
Mohammed Nabeel ◽  
...  
Keyword(s):  
Average Length ◽  
International Classification Of Diseases ◽  
Hospital Performance ◽  
Sleep Apnoea ◽  
Chronic Obstructive ◽  
Unplanned Readmission ◽  
Continuous Variables ◽  
Post Traumatic Stress ◽  
Sampling Weights ◽  
Obstructive Sleep

IntroductionHospital quality improvement and hospital performance are commonly evaluated using parameters such as average length of stay (LOS), patient safety measures and rates of hospital readmission. Thirty-day readmission (30-DR) rates are widely used as a quality indicator and a quantifiable metric for hospitals since patients are often readmitted for the exacerbation of conditions from index admission. The quality of patient education and postdischarge care can influence readmission rates. We report the 30-DR rates of patients with asthma using a national dataset for the year 2013.ObjectivesThe aim of our study was to assess the 30- day readmission (30-DR) rate as well as, the causes and predictors of readmissions.Study designs/methodsUsing the Nationwide Readmission Database (NRD) (2013), we identified primary discharge diagnoses of asthma by using International Classification of Diseases, Ninth Revision, Clinical Modification code ‘493’. Categorical and continuous variables were assessed by a χ2 test and a Student’s t-test, respectively. The independent predictors of unplanned 30-DR were detected by multivariate analysis. We used sampling weights, which are provided in the NRD, to generate the national estimates.ResultsThere were 130 490 (weighted N=311 173) inpatient asthma admissions during 2013. The overall 30-DR for asthma was 11.9%. The associated factors for 30-DR were age 45–84 years (40.32% vs 29.05%; p<0.001), enrolment in Medicare (49.33% vs 30.61% p<0.001), extended LOS (mean, 4.40±0.06 vs 3.25±0.04 days; p<0.001), higher mean cost (US$8593.91 vs US$6741.31; p<0.001) and higher disposition against medical advice (DAMA) (4.14% vs 1.51%; p<0.001). The factors that increased the chance of 30-DR were advanced age (≥45–64 vs ≤17 years; OR 4.61, 95% CI 4.04 to 5.27, p<0.0001), male sex (OR 1.19, 95% CI 1.13 to 1.26, p<0.0001), a higher Charlson Comorbidity Index (CCI) (OR 1.16, 95% CI 1.14 to 1.18, p<0.0001), DAMA (OR 2.32, 95% CI 2.08 to 2.59, p<0.0001), non-compliance with medication (OR 1.34, 95% CI 1.24 to 1.46, p<0.0001), post-traumatic stress disorder (OR 1.48, 95% CI 1.22 to 1.79, p<0.0001), alcohol use (OR 1.45, 95% CI 1.27 to 1.65, p<0.0001), gastro-oesophageal reflux disease (OR 1.20, 95% CI 1.14 to 1.27, p<0.0001), obstructive sleep apnoea (OR 1.11, 95% CI 1.03 to 1.18, p<0.0042) and hypertension (OR 1.11, 95% CI 1.06 to 1.17, p<0.0001).ConclusionsWe found that the overall 30-DR rate for asthma was 11.9% all-cause readmission. Major causes of 30-DR were asthma exacerbation (36.74%), chronic obstructive pulmonary disease (11.47%), respiratory failure (6.46%), non-specific pneumonia (6.19%), septicaemia (3.61%) and congestive heart failure (3.32%). One-fourth of the revisits occurred in the first week, while half of the revisits took place in the first 2 weeks. Education regarding illness and the importance of medicine compliance could play a significant role in preventing asthma-related readmission.

scholarly journals COVID-19 associated viral myocarditis: does it exist?

2020 ◽  
Vol 90 (4) ◽  
Author(s):  
Vaishali Verma ◽  
Sachin Sondhi ◽  
Rajesh Sharma ◽  
Kunal Mahajan
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Myocardial Injury ◽  
Viral Myocarditis ◽  
Morbidity And Mortality ◽  
Elevated Troponin ◽  
Respiratory Involvement

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is a lethal pandemic that has claimed millions of lives worldwide. While respiratory involvement is the most common and most virulent manifestation of COVID-19, there is enough data to suggest that myocardial injury reflected through elevated troponin levels is seen in around 7-28% of patients and is related with increased morbidity and mortality.

Renal Function and Scaled Troponin in Patients Presenting to the Emergency Department with Symptoms of Myocardial Infarction

2017 ◽  
Vol 45 (4) ◽  
pp. 304-309 ◽  
Author(s):  
Anupama Vasudevan ◽  
Adam J. Singer ◽  
Christopher DeFilippi ◽  
Gary Headden ◽  
Jeffrey M. Schussler ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Renal Dysfunction ◽  
Myocardial Injury ◽  
Estimated Glomerular Filtration Rate ◽  
Elevated Troponin ◽  
Disease Epidemiology ◽  
Acute Myocardial Injury ◽  
Multicenter Prospective Study ◽  
Cardiac Troponins

Background: Cardiac troponins are often found to be elevated in patients with renal dysfunction, even in the absence of acute myocardial injury. The objective of this report was to characterize the scaled troponin values and proportion of adjudicated acute myocardial infarction (AMI) among patients with and without renal dysfunction. Methods: The data was from a multicenter prospective study including patients presenting to the emergency department with symptoms of AMI. Troponin measurements were standardized across various assays by calculating the observed results as multiples of the assay-specific 99th percentile upper limit of normal. Patients with an estimated glomerular filtration rate (eGFR; calculated by the Chronic Kidney Disease Epidemiology Collaboration formula) <60 mL/min/1.73 m2 were considered to have renal dysfunction. Results: Of 430 included patients, 249 (58%) were male and 181 (42%) were female, with a mean age of 55.9 ± 12.3 and 57.3 ± 12.8 years, respectively. Eighty-seven (20.2%) had renal dysfunction. The proportions of patients with at least one scaled troponin value above the 99th percentile cut-off point among patients with and without renal dysfunction were 40 (45.9%) and 81 (23.6%) respectively (p < 0.001). The proportions of patients with an adjudicated diagnosis of AMI among those with and without renal dysfunction were 20.7 and 18.7%, respectively (p = 0.67). Using scaled troponins, by the second test there was >5X and by the third test >15X separation in the excursion of troponin among those with AMI compared to those without. Conclusions: One or more elevated troponin values are common in those with renal dysfunction. Scaled troponins for eGFR groups were similar, indicating that the use of this interpretative technique is applicable in discerning AMI for those with and without renal dysfunction.

scholarly journals Characteristics and clinical significance of myocardial injury in patients with severe coronavirus disease 2019

2020 ◽  
Vol 41 (22) ◽  
pp. 2070-2079 ◽  
Author(s):  
Shaobo Shi ◽  
Mu Qin ◽  
Yuli Cai ◽  
Tao Liu ◽  
Bo Shen ◽  
...  
Keyword(s):  
Clinical Significance ◽  
Myocardial Injury ◽  
Troponin I ◽  
Clinical Laboratory ◽  
Characteristic Curve ◽  
Hospital Death ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Cardiovascular Comorbidities ◽  
High Level

Abstract Aims To investigate the characteristics and clinical significance of myocardial injury in patients with severe coronavirus disease 2019 (COVID-19). Methods and results We enrolled 671 eligible hospitalized patients with severe COVID-19 from 1 January to 23 February 2020, with a median age of 63 years. Clinical, laboratory, and treatment data were collected and compared between patients who died and survivors. Risk factors of death and myocardial injury were analysed using multivariable regression models. A total of 62 patients (9.2%) died, who more often had myocardial injury (75.8% vs. 9.7%; P &lt; 0.001) than survivors. The area under the receiver operating characteristic curve of initial cardiac troponin I (cTnI) for predicting in-hospital mortality was 0.92 [95% confidence interval (CI), 0.87–0.96; sensitivity, 0.86; specificity, 0.86; P &lt; 0.001]. The single cut-off point and high level of cTnI predicted risk of in-hospital death, hazard ratio (HR) was 4.56 (95% CI, 1.28–16.28; P = 0.019) and 1.25 (95% CI, 1.07–1.46; P = 0.004), respectively. In multivariable logistic regression, senior age, comorbidities (e.g. hypertension, coronary heart disease, chronic renal failure, and chronic obstructive pulmonary disease), and high level of C-reactive protein were predictors of myocardial injury. Conclusion The risk of in-hospital death among patients with severe COVID-19 can be predicted by markers of myocardial injury, and was significantly associated with senior age, inflammatory response, and cardiovascular comorbidities.

Sign in / Sign up

Export Citation Format

Share Document