The absolute and relative changes in high-sensitivity cardiac troponin I are associated with the in-hospital mortality of patients with fulminant myocarditis

Abstract Background We sought to describe the tendency and extent of high-sensitivity cardiac troponin I (hs-cTnI) changes in patients with fulminant myocarditis (FM) after admission and to explore the relationship between the in-hospital mortality of FM and the absolute and relative changes in hs-cTnI within 24 h and 48 h after admission. Methods In the retrospective study, the object are patients diagnosed with FM in our single centre. The value of cardiac troponin was recorded after patients admitted to hospital in succession. The absolute and relative changes in hs-cTnI within 24 h and 48 h were described as range distributions. Receiver operating characteristic (ROC) curve and Cox analyses were performed to determine the relationship between in-hospital mortality of FM and hs-cTnI changes. Results A total of 83 FM patients admitted to our centre from January 1, 2010 to December 31, 2019 were included; 69 patients survived and 14 patients died. In the survival group, 78% of patients experienced a decline in hs-cTnI within 24 h, while 36% of the mortality group exhibited a declining tendency in hs-cTnI (P = 0.003). Nearly 60% of survival group had a 0–2000 ng/l reduction in troponin from baseline within 24 h of admission. However, troponin levels of 50% of patients in the mortality group were 0–10,000 ng/ L higher than baseline 24 h after admission. Multivariable logistic analysis revealed that the declining tendency of hs-cTnI within 24 h, in addition to time from onset to admittance to hospital, intravenous immunoglobulin treatment and the abnormal level of creatinine, were associated with the in-hospital mortality of FM (for the declining tendency of hs-cTnI within 24 h, OR = 0.10, 95% CI 0.02–0.68, P = 0.018). The ROC curve revealed optimal cut-off values of − 618 ng/l for absolute change within 24 h (AUC = 0.800, P < 0.01), − 4389 ng/l for absolute change within 48 h (area under the curve = 0.711, P < 0.01), − 28.46% for relative change within 24 h (AUC = 0.810, P < 0.01), and − 52.23% for relative change within 48 h (AUC = 0.795, P < 0.01). Absolute changes and relative changes in hs-cTnI within 24 h and 48 h were strong predictors of in-hospital mortality by Cox regression analysis after adjustment for sex, time from onset to admission, and occurrence of ventricular tachycardia or ventricular fibrillation. Conclusion Most FM patients who survived experienced a decline in hs-cTnI within 24 h. The absolute and relative changes in hs-cTnI within 24 h and 48 h were strong predictors of in-hospital mortality.

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The absolute and relative change of high-sensitivity cardiac troponin I are associated with in-hospital outcome of patients with fulminant myocarditis

10.21203/rs.3.rs-133930/v1 ◽

2021 ◽

Author(s):

Chao Liu ◽

Zhongqin Wang ◽

Kengquan Chen ◽

Guanglin Cui ◽

Chen chen ◽

...

Keyword(s):

Hospital Mortality ◽

Cardiac Troponin ◽

Troponin I ◽

High Sensitivity ◽

Fulminant Myocarditis ◽

Absolute Change ◽

Hospital Outcome ◽

The Absolute ◽

Relative Change ◽

The Relationship

Abstract Background we sought to describe the tendency and extent of high-sensitivity cardiac troponin I (hs-cTnI) changes in patients with fulminant myocarditis (FM) after admission, and to explore the relationship between in-hospital outcome of FM and the value of absolute and relative change of hs-cTnI within 24 h and 48 h after admission. Methods a total of 83 cases of FM patient admitted to our center from January 1, 2010 to December 31, 2019 were included, 69 patients survived and 14 patients died. The absolute and relative change of hs-cTnI within 24 h and 48 h were described as range distribution. Receiver operating characteristic (ROC) curves and Cox analysis were performed to determine the relationship between in-hospital outcome of FM and hs-cTnI change. Results In survive group, 78% patients experienced the decline of hs-cTnI within 24 h, while 36% of death group had the declined tendency of hs-cTnI (P = 0.003). Absolute and relative change of hs-cTnI within 24 h and 48 h were displayed as range distribution. Multivariate analysis revealed that the decline tendency of hs-cTnI change within 24 h, in addition with time from onset to hospital, intravenous immunoglobulin treatment and abnormal of creatinine, were associated with the outcome of FM (for the decline tendency of hs-cTnI within 24 h, OR = 0.10, 95% CI = 0.02–0.68, P = 0.018). ROC curve revealed optimized cutoff values of -0.618 ng/ml for absolute change within 24 h (AUC = 0.800, P < 0.01), -4.389 ng/ml for absolute change within 48 h (Area Under Curve = 0.711, P < 0.01), -28.46% for relative change within 24 h (AUC = 0.810, P < 0.01), -52.23% for relative change within 48 h (AUC = 0.795, P < 0.01). Absolute change and relative change of hs-cTnI within 24 h and 48 h were strong predictors of in-hospital mortality by COX regression analyzed, after the adjustment for gender, time from onset to admission, occurrence of ventricular tachycardia or ventricular fibrillation. Conclusion Most survive FM patients experienced the decline of hs-cTnI within 24 h. The absolute and relative change of hs-cTnI within 24 h and 48 h were strong predictors of in-hospital mortality.

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Cardiac biomarkers as prognosticators among SARS-CoV-19 patients in a tertiary hospital in Philippines

European Heart Journal ◽

10.1093/eurheartj/ehab724.2494 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

R Ong ◽

C Chacon ◽

S Javier

Keyword(s):

Creatine Kinase ◽

Logistic Regression ◽

Hospital Mortality ◽

Roc Curve ◽

Predictive Value ◽

Troponin I ◽

Binary Logistic Regression ◽

High Sensitivity ◽

Cardiac Biomarkers ◽

Optimal Cutoff

Abstract Background There is overwhelming volume of confirmed cases of COVID-19, despite this numerous knowledge gaps remain in the diagnosis, management, and prognostication of this novel coronavirus infection, making prevention and control a challenge. Methods This retrospective cohort study included patients with real-time reverse transcriptase polymerase chain reaction (rRT-PCR)-confirmed COVID-19. Binary logistic regression was used to determine the association between the cardiac biomarkers and in-hospital mortality. ROC, AUC, and cutoff analyses were used to determine optimal cutoff values for the cardiac biomarkers. Results A total of 90 subjects with a complete panel of cardiac biomarkers out of the 224 rRT-PCR confirmed cases were included. The median age was 57 years (IQR, 47–67 years), majority were males. Sixty-six (77.6%) subjects survived while 19 (22.4%) expired. The most common presenting symptom was fever (75.6%), and the most common comorbidity was hypertension (67.8%). Spearman rho correlation analysis showed moderate positive association of high sensitivity troponin I (hsTnI) with in-hospital mortality (R, 0.434, p = <0.001). Multivariate binary logistic regression analysis showed that creatine kinase and hsTnI were independently associated with in-hospital mortality (OR, 4.103 [95% CI, 1.241–13.563], p=0.021; and OR, 7.899 [95% CI, 2.430–25.675], p=0.001, respectively). ROC curve analysis showed that hsTnI was a good predictor for in-hospital mortality (AUC, 0.829 [95% CI, 0.735–0.923], p = <0.001) and that creatine kinase was a poor predictor (AUC, 0.677 [95% CI, 0.531–0.823], p=0.018). Optimal cutoff point derived from the ROC curve for hsTnI was 0.010 ng/ml (J, 0.574) with a sensitivity of 84% (TPR, 0.842 [95% CI, 0.604–0.966]), specificity of 73% (TNR, 0.732 [95% CI, 0.614–0.386]), and an adjusted negative predictive value of 99% (Known prevalence*adjusted NPV, 0.989), a positive likelihood ratio of 20% (LR+, 3.147 [95% CI, 2.044–4.844]) and a negative likelihood ratio of 30% (LR−, 0.216 [95% CI, 0.076–0.615]). Conclusion High sensitivity troponin I level was a good tool with a very high negative predictive value in significantly predicting in-hospital mortality among rRT-PCR positive COVID-19 patients. FUNDunding Acknowledgement Type of funding sources: None. ROC Curve

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Biomarkers for Thrombosis in COVID-19: A Role for High Sensitivity Troponin-I and Immature Platelet Fraction?

Blood ◽

10.1182/blood-2021-151226 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 4260-4260

Author(s):

Bilal Ashraf ◽

Haekyung Jeon-slaughter ◽

Christopher Webb ◽

Nicholas C.J. Lee ◽

Weina Chen ◽

...

Keyword(s):

Platelet Count ◽

Cardiac Troponin ◽

Troponin I ◽

High Sensitivity ◽

Cardiac Troponin I ◽

Immature Platelet Fraction ◽

Increased Risk ◽

Immature Platelets ◽

The Relationship ◽

D Dimer

Abstract Biomarkers for Thrombosis in COVID-19: A Role for High Sensitivity Troponin-I and Immature Platelet Fraction? Introduction Coronavirus disease 2019 (COVID-19) is associated with increased risk of thrombosis with both venous and arterial thromboembolism observed. While d-dimer elevation has been shown to be associated with thrombosis, this elevation is present in over 50% of COVID-19 infections demonstrating a clear need for more specific biomarkers of thrombosis in this population. While there are a variety of theories to explain the increased risk for thrombosis: all center on Virchow's triad, specifically hypercoagulability and inflammation. Platelets play a significant role in hypercoagulability. Immature platelets, which are thought to be hyper-reactive, may specifically be associated with thrombosis in COVID-19. It would thus be reasonable to expect immature platelet fraction (IPF) and immature platelet count (IPC) to be predictive biomarkers of thrombosis in this population. Beyond hypercoagulability, High-Sensitivity (HS) Cardiac troponin-I can be a biomarker of inflammation and may also be predictive of thrombotic events in COVID-19. The aim of this study was to evaluate the relationship between IPF, IPC, HS cardiac troponin-I and thrombotic events in COVID-19. Methods Using a single center COVID-19 data registry, we extracted all patients with COVID-19 at our single center between May 1, 2020 and January 1, 2021. Patients were stratified into two groups based on thrombotic events during hospitalization, the thrombosis and no thrombosis groups. Biomarker values, including IPF, IPC, platelet counts, d-dimer, and HS cardiac troponin I were extracted. Two-sided Wilcoxon rank test was conducted to test group differences in IPF, IPC, platelet, d-dimer, and HS cardiac troponin-I values. Results There were no significant differences in measurements of IPF at admission, peak IPF , platelet count at admission, peak platelet count, IPC at admission, and peak IPC between the thrombosis and no thrombosis groups. Minimum platelet count values were significantly lower in the thrombosis group compared to the no thrombosis group. D-dimer and troponin values were significantly higher in the thrombosis group than the no thrombosis group. (Table 1) Discussion To our knowledge this is the first study assessing the relationship between IPF, IPC, HS cardiac troponin-I and thrombosis in COVID-19. HS cardiac troponin did appear to be a predictive biomarker for thrombosis in COVID-19. This may be related to vascular inflammation playing a significant role in thrombosis. It may also be secondary to myocardial inflammation associated with severe disease in COVID-19.3 Patients with more severe disease are more prone to thrombosis. Unsurprisingly, our study corroborates evidence in the literature that d-dimer is associated with thrombotic events in COVID-19. On the other hand, IPF and IPC do not appear to be predictive biomarkers for thrombosis in this cohort. This appears consistent with the limited data assessing the relationship between IPF, IPC, and thrombosis outside of COVID-19. This does not dispel the importance of immature platelets in COVID-19, however. IPF and IPC are increased in patients with COVID-19, and our published data indicates they are predictors of COVID-19 severity. However, the relationship between immature platelets and outcomes in acute illness can be complex, as in sepsis, where the trend of IPC is associated with mortality, rather than the initial value. Future studies should delineate the relationship between trends in IPF or IPC and outcomes in COVID-19. Furthermore, it is crucial to define biomarkers of thrombosis and disease severity and mortality in COVID-19 which can potentially guide therapeutic interventions. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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Evaluation of the Correlation Between Cardiac Troponin I Versus Causes of Admission and In-Hospital Mortality in End-Stage Renal Disease Patients

Nephro-Urology Monthly ◽

10.5812/numonthly.119304 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Shahram Taheri ◽

Zahra Tavassoli-Kafrani ◽

Sayed Mohsen Hosseini

Keyword(s):

Renal Disease ◽

Hospital Mortality ◽

End Stage Renal Disease ◽

Cardiac Troponin ◽

Troponin I ◽

Cardiac Troponin I ◽

Stage Renal Disease ◽

End Stage ◽

The Relationship ◽

Esrd Patients

Objectives: There are arguments regarding the relationship between the level of cardiac troponin I (cTnI) and presence of cardiac diseases in end-stage renal disease (ESRD) patients. This study aimed to determine the relationship between positivity of cTnI and cause of admission and patients’ outcome in ESRD patients. Methods: In this cross-sectional study, all ESRD patients who had checked cTnI and admitted to two university hospitals in Isfahan, Iran were enrolled. The patients’ demographic characteristics, cause of admission, and outcome were correlated with cTnI positivity. Results: Out of a total of 348 ESRD patients, 100 subjects had positive cTnI. There was a positive correlation between age and admission in Al-Zahra hospital with positive cTnI. In contrast, vascular access complication and hypertension had a negative correlation with positivity of cTnI. The results of multiple logistic regression analysis showed that factors including age (OR: 1.04; 95% CI: 1.01 - 1.07; P: 0.004) and infections (OR: 3.1; 95% CI: 1.3 - 7.3; P: 0.009) were associated with increased risk of in-hospital mortality. In contrary, exit site infection (OR: 0.11; 95% CI: 0.01 - 0.8; P: 0.03) and hypertension (OR = 0.32; 95% CI: 0.14 - 0.77; P = 0.01) were associated with decreased risk of mortality. Although cTnI positivity correlated with patients’ in-hospital mortality (OR = 2.038). Conclusions: Although positive cTnI had a borderline association with in-hospital mortality in ESRD patients, further multicenter studies with larger sample size are required to confirm the results.

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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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Associations with the In-Hospital Survival Following Extracorporeal Membrane Oxygenation in Adult Acute Fulminant Myocarditis

Journal of Clinical Medicine ◽

10.3390/jcm7110452 ◽

2018 ◽

Vol 7 (11) ◽

pp. 452 ◽

Cited By ~ 6

Author(s):

Shaur-Zheng Chong ◽

Chih-Yuan Fang ◽

Hsiu-Yu Fang ◽

Huang-Chung Chen ◽

Chien-Jen Chen ◽

...

Keyword(s):

Lactic Acid ◽

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Troponin I ◽

Cox Regression ◽

Laboratory Data ◽

Cardiac Biomarkers ◽

Fulminant Myocarditis ◽

Survival Group ◽

Membrane Oxygenation

Background: Acute fulminant myocarditis (AFM) is a serious disease that progresses rapidly, and leads to failing respiratory and circulatory systems. When medications fail to reverse the patient’s clinical course, extracorporeal membrane oxygenation (ECMO) is considered the most effective, supportive and adjunct strategy. In this paper we analyzed our experience in managing AFM with ECMO support. Methods: During October 2003 and February 2017, a total of 35 patients (≥18 years) were enrolled in the study. Twenty patients survived, and another 15 patients expired. General demographics, the hemodynamic condition, timing of ECMO intervention, and laboratory data were compared for the survival and non-survival groups. Univariate and multivariate Cox regression analyses were performed to identify the associations with in-hospital mortality following ECMO use in this situation. Results: The survival rate was 57.1% during the in-hospital period. The average age, gender, severity of the hemodynamic condition, and cardiac rhythm were similar between the survival and non-survival groups. Higher serum lactic acid (initial and 24 h later), higher peak cardiac biomarkers, higher incidence of acute kidney injury and the need for hemodialysis were noted in the non-survival group. Higher 24-h lactic acid levels and higher peak troponin-I levels were associated with in-hospital mortality. Conclusions: When ECMO was used for AFM, related cardiogenic shock and decompensated heart failure, higher peak serum troponin-I levels and 24-h serum lactic acid levels following ECMO use were independently associated with in-hospital mortality.

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