scholarly journals Joint predictive value of cTnI and NT-proBNP on mortality in patients with coronavirus disease 2019: A retrospective research in Wuhan, China

2021 ◽  
Vol 9 (3) ◽  
pp. 177-184
Author(s):  
Haoyu Weng ◽  
Fan Yang ◽  
Long Zhang ◽  
Han Jin ◽  
Shengcong Liu ◽  
...  
Keyword(s):  
High Risk ◽  
Confidence Interval ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Cox Regression ◽  
Cardiac Injury ◽  
Predictive Values ◽  
Course Of Disease ◽  
Risk Of Death ◽  
The World

Abstract Background and Objectives The pandemic of coronavirus disease 2019 (COVID-19) remains to be the biggest public threat all over the world. Because of the rapid deterioration in some patients, markers that could predict poor clinical outcomes are urgently required. This study was to evaluate the predictive values of cardiac injury parameters, including cardiac troponin I (cTnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, on mortality in COVID-19 patients. Methods COVID-19 patients in Zhongfaxincheng branch of Tongji Hospital (Wuhan, China) from February 8–28, 2020, were enrolled in this study. We followed up the patients for 30 days after admission. Results A total of 134 patients were included in the study. Multivariate Cox regression showed that 1) patients with elevated cTnI levels had a higher risk of death (hazard ratio [HR] 7.33, 95% confidence interval [CI] 2.56–21.00) than patients with normal cTnI levels; 2) patients with elevated NT-proBNP levels had a higher risk of death (HR 27.88, 95% CI 3.55–218.78) than patients with normal NT-proBNP levels; 3) patients with both elevated cTnI and NT-proBNP levels had a significantly higher risk of death (HR 53.87, 95% CI 6.31–459.91, P < 0.001) compared to patients without elevated cTnI or NT-proBNP levels; 4) the progressions of cTnI and NT-proBNP levels were also correlated with death (HR 12.70, 95% CI 3.94–40.88, P < 0.001 and HR 51.09, 95% CI 5.82–448.26, P < 0.001). Conclusions In COVID-19 patients, cTnI and NT-proBNP levels could be monitored to identify patients at a high risk of death in their later course of disease.

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 biomarkers in acute respiratory distress syndrome: a systematic review and meta-analysis

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Dilip Jayasimhan ◽  
Simon Foster ◽  
Catherina L. Chang ◽  
Robert J. Hancox
Keyword(s):  
Systematic Review ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Cardiac Dysfunction ◽  
Distress Syndrome ◽  
Troponin I ◽  
Meta Analysis ◽  
Cardiac Injury ◽  
Cardiac Biomarkers ◽  
Risk Of Death

Abstract Background Acute respiratory distress syndrome (ARDS) is a leading cause of morbidity and mortality in the intensive care unit. Biochemical markers of cardiac dysfunction are associated with high mortality in many respiratory conditions. The aim of this systematic review is to examine the link between elevated biomarkers of cardiac dysfunction in ARDS and mortality. Methods A systematic review of MEDLINE, EMBASE, Web of Science and CENTRAL databases was performed. We included studies of adult intensive care patients with ARDS that reported the risk of death in relation to a measured biomarker of cardiac dysfunction. The primary outcome of interest was mortality up to 60 days. A random-effects model was used for pooled estimates. Funnel-plot inspection was done to evaluate publication bias; Cochrane chi-square tests and I2 tests were used to assess heterogeneity. Results Twenty-two studies were included in the systematic review and 18 in the meta-analysis. Biomarkers of cardiac stretch included NT-ProBNP (nine studies) and BNP (six studies). Biomarkers of cardiac injury included Troponin-T (two studies), Troponin-I (one study) and High-Sensitivity-Troponin-I (three studies). Three studies assessed multiple cardiac biomarkers. High levels of NT-proBNP and BNP were associated with a higher risk of death up to 60 days (unadjusted OR 8.98; CI 4.15-19.43; p<0.00001). This association persisted after adjustment for age and illness severity. Biomarkers of cardiac injury were also associated with higher mortality, but this association was not statistically significant (unadjusted OR 2.21; CI 0.94-5.16; p= 0.07). Conclusion Biomarkers of cardiac stretch are associated with increased mortality in ARDS.

scholarly journals Clinical Features of Maintenance Hemodialysis Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China

2020 ◽  
Vol 15 (8) ◽  
pp. 1139-1145 ◽  
Author(s):  
Jun Wu ◽  
Jushuang Li ◽  
Geli Zhu ◽  
Yanxia Zhang ◽  
Zhimin Bi ◽  
...  
Keyword(s):  
Clinical Features ◽  
Troponin I ◽  
Clinical Laboratory ◽  
Cardiac Injury ◽  
Hemodialysis Patients ◽  
Hospitalized Patients ◽  
Maintenance Hemodialysis ◽  
Computed Tomographic ◽  
Risk Of Death ◽  
Novel Coronavirus

Background and objectivesPrevious reports on the outbreak of coronavirus disease 2019 were on the basis of data from the general population. Our study aimed to investigate the clinical features of patients on maintenance hemodialysis.Design, setting, participants, & measurements In this retrospective, single-center study, we included 49 hospitalized patients on maintenance hemodialysis and 52 hospitalized patients without kidney failure (controls) with confirmed coronavirus disease 2019 at Tongren Hospital of Wuhan University from January 30, 2020 to March 10, 2020. Demographic, clinical, laboratory, and radiologic characteristics and treatment and outcomes data were analyzed. The final date of follow-up was March 19, 2020.ResultsThe median age of 101 patients was 62 years (interquartile range, 49–72). All patients were local residents of Wuhan. In terms of common symptoms, there were differences between patients on hemodialysis and controls (fatigue [59% versus 83%], dry cough [49% versus 71%], and fever [47% versus 90%]). Lymphocyte counts were decreased (0.8×109/L [patients on hemodialysis] versus 0.9×109/L [controls], P=0.02). Comparing patients on hemodialysis with controls, creatine kinase–muscle and brain type, myoglobin, hypersensitive troponin I, B-type natriuretic peptide, and procalcitonin were increased, and the percentage of abnormalities in bilateral lung was higher in computed tomographic scan (82% versus 69%, P=0.15) and unilateral lung was lower (10% versus 27%, P=0.03). Common complications including shock, acute respiratory distress syndrome, arrhythmia, and acute cardiac injury in patients on hemodialysis were significantly higher. Compared with controls, more patients on hemodialysis received noninvasive ventilation (25% versus 6%, P=0.008). As of March 19, 2020, three patients on hemodialysis (6%) were transferred to the intensive care unit and received invasive ventilation. Seven patients on hemodialysis (14%) had died.ConclusionsThe main symptoms of coronavirus disease 2019 pneumonia, including fever and cough, were less common in patients on hemodialysis. Patients on hemodialysis with coronavirus disease 2019 were at higher risk of death.

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 Disability in people clinically at high risk of psychosis

2010 ◽  
Vol 197 (4) ◽  
pp. 278-284 ◽  
Author(s):  
Eva Velthorst ◽  
Dorien H. Nieman ◽  
Don Linszen ◽  
Hiske Becker ◽  
Lieuwe de Haan ◽  
...  
Keyword(s):  
High Risk ◽  
Help Seeking ◽  
Cox Regression ◽  
World Health ◽  
Disability Assessment ◽  
Community Activities ◽  
Transition Group ◽  
The World ◽  
Health Organization

BackgroundDecline in social functioning occurs in individuals who later develop psychosis.AimsTo investigate whether baseline differences in disability are present in those who do and those who do not make a transition to psychosis in a group clinically at high risk and whether disability is a risk factor for transition.MethodProspective multicentre, naturalistic field study with an 18-month follow-up period on 245 help-seeking individuals clinically at high risk. Disability was assessed with the Disability Assessment Schedule of the World Health Organization (WHODAS–II).ResultsAt baseline, the transition group displayed significantly greater difficulties in making new friends (z =−3.40, P = 0.001), maintaining a friendship (z =−3.00, P = 0.003), dealing with people they do not know (z =−2.28, P = 0.023) and joining community activities (z =−2.0, P = 0.05) compared with the non-transition group. In Cox regression, difficulties in getting along with people significantly contributed to the prediction of transition to psychosis in our sample (β = 0.569, s.e. = 0.184, Wald = 9.548, P = 0.002, hazard ratio (HR) = 1.767, 95% CI 1.238–2.550).ConclusionsCertain domains of social disability might contribute to the prediction of psychosis in a sample clinically at high risk.

Comparable detection of acute myocardial infarction by creatine kinase MB isoenzyme and cardiac troponin I

1994 ◽  
Vol 40 (7) ◽  
pp. 1291-1295 ◽  
Author(s):  
J E Adams ◽  
K B Schechtman ◽  
Y Landt ◽  
J H Ladenson ◽  
A S Jaffe
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Creatine Kinase ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Characteristic Curve ◽  
Cardiac Injury ◽  
Cardiac Troponin I ◽  
Creatine Kinase Mb ◽  
Coronary Care

Abstract Although measurement of cardiac troponin I (cTnI) is, in some situations, more specific for detection of cardiac injury than is measurement of the MB isoenzyme of creatine kinase (MBCK), its sensitivity and specificity relative to MBCK for detection of myocardial infarction has not been established. Accordingly, we studied prospectively 199 consecutive patients admitted to the coronary care unit. Values of MBCK and cTnI mass were determined in all samples. Of the 188 patients admitted with a suspicion of acute myocardial ischemia, 89 were diagnosed as having an acute myocardial infarction on the basis of the patterns of MBCK values. Eighty-six of these patients also had increased cTnI (concordance, 96.6%); three did not. Of the patients diagnosed as without infarction, five with unstable angina and symptoms in the day(s) prior to admission had increased cTnI, for a cTnI specificity of 94.9%. Receiver operating characteristic curve analysis indicated that cTnI and MBCK had statistically indistinguishable diagnostic accuracies for the detection of acute myocardial infarction.

scholarly journals Risk factors for myocardial injury and death in patients with COVID-19: insights from a cohort study with chest computed tomography

2020 ◽  
Vol 116 (14) ◽  
pp. 2239-2246 ◽  
Author(s):  
Giuseppe Ferrante ◽  
Fabio Fazzari ◽  
Ottavia Cozzi ◽  
Matteo Maurina ◽  
Renato Bragato ◽  
...  
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Cohort Study ◽  
Myocardial Injury ◽  
Troponin I ◽  
Cox Regression ◽  
Chest Ct ◽  
Chest Computed Tomography ◽  
Risk Of Death ◽  
Increased Risk

Abstract Aims Whether pulmonary artery (PA) dimension and coronary artery calcium (CAC) score, as assessed by chest computed tomography (CT), are associated with myocardial injury in patients with coronavirus disease 2019 (COVID-19) is not known. The aim of this study was to explore the risk factors for myocardial injury and death and to investigate whether myocardial injury has an independent association with all-cause mortality in patients with COVID-19. Methods and Results This is a single-centre cohort study including consecutive patients with laboratory-confirmed COVID-19 undergoing chest CT on admission. Myocardial injury was defined as high-sensitivity troponin I &gt;20 ng/L on admission. A total of 332 patients with a median follow-up of 12 days were included. There were 68 (20.5%) deaths; 123 (37%) patients had myocardial injury. PA diameter was higher in patients with myocardial injury compared with patients without myocardial injury [29.0 (25th–75th percentile, 27–32) mm vs. 27.7 (25–30) mm, P &lt; 0.001). PA diameter was independently associated with an increased risk of myocardial injury [adjusted odds ratio 1.10, 95% confidence interval (CI) 1.02–1.19, P = 0.01] and death [adjusted hazard ratio (HR) 1.09, 95% CI 1.02–1.17, P = 0.01]. Compared with patients without myocardial injury, patients with myocardial injury had a lower prevalence of a CAC score of zero (25% vs. 55%, P &lt; 0.001); however, the CAC score did not emerge as a predictor of myocardial injury by multivariable logistic regression. Myocardial injury was independently associated with an increased risk of death by multivariable Cox regression (adjusted HR 2.25, 95% CI 1.27–3.96, P = 0.005). Older age, lower estimated glomerular filtration rate, and lower PaO2/FiO2 ratio on admission were other independent predictors for both myocardial injury and death. Conclusions An increased PA diameter, as assessed by chest CT, is an independent risk factor for myocardial injury and mortality in patients with COVID-19. Myocardial injury is independently associated with an approximately two-fold increased risk of death.

scholarly journals Functionalized Graphene Quantum Dot Interfaced Electrochemical Detection of Cardiac Troponin I: An Antibody Free Approach

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Muthaiyan Lakshmanakumar ◽  
Noel Nesakumar ◽  
Swaminathan Sethuraman ◽  
K. S. Rajan ◽  
Uma Maheswari Krishnan ◽  
...  
Keyword(s):  
Electrochemical Detection ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Graphene Quantum Dots ◽  
Cardiac Troponin I ◽  
World Health ◽  
Infrared Spectrometry ◽  
Cooh Group ◽  
Functionalized Graphene ◽  
The World

AbstractAccording to the World Health Organization (WHO), cardiovascular disease (CVD) is the leading cause of death in the world every year. The design and development of biosensors for the detection of CVD markers could be one of the major contributions of the scientific community to society. In this context, acetic acid functionalized graphene quantum dots (fGQDs) were used as an interface for the electrochemical detection of cardiac Troponin I (cTnI). The interaction of cTnI with fGQDs for the early diagnosis of acute myocardial infarction was investigated using cyclic voltammetry (CV) and amperometry. The carbodiimide conjugation between the N-H group of cTnI and the functionalized COOH group on GQDs enabled the detection of cTnI biomarker. The same sensing mechanism was confirmed using Fourier Transform Infrared Spectrometry (FTIR). The fGQDs modified Au electrode showed remarkable electrocatalytic oxidation of cTnI with good stability and sensitivity over a linear range of 0.17 to 3 ng mL−1 and a low detection limit of 0.02 ng mL−1. Bland-Altman plots substantiate a bias between the intra-/inter-cTnI assay and calibrated cTnI assay with 95% limits of agreement (mean difference ± 1.96 SD). The aim of this study is to describe an innovative method to detect cardiac biomarker cTnI and provide preliminary data on its diagnostic capacity. At the same time, its applicability in clinical setting will have to be validated with a significant number of samples collected from patients.

scholarly journals Sensitivity and Specificity of Community Fecal Immunotesting Screening for Colorectal Carcinoma in a High-Risk Canadian Population

2015 ◽  
Vol 139 (11) ◽  
pp. 1441-1445 ◽  
Author(s):  
Amber L. Crouse ◽  
Lawrence De Koning ◽  
S. M. Hossein Sadrzadeh ◽  
Christopher Naugler
Keyword(s):  
High Risk ◽  
Colorectal Carcinoma ◽  
Confidence Interval ◽  
Primary Care Physicians ◽  
Screening Method ◽  
Older Individuals ◽  
Predictive Values ◽  
Fecal Immunochemical Testing ◽  
Colonic Adenomas ◽  
Operational Test

Context Community-based programs are a common way of promoting colorectal cancer screening by primary care physicians. Fecal immunochemical testing (FIT) is a screening method commonly used in such programs. Fecal immunochemical testing has advantages to the patient as well as to clinical laboratories. Objective To assess the operational test characteristics of a FIT pilot program in Calgary, Alberta, Canada, between April 2011 and May 2012. Design Four hundred fifty-seven high-risk patients undergoing both FIT and colonoscopy were included. Areas under the curve and positive predictive values were derived for FIT values and biopsy-proven neoplasia. Subgroup analysis was also performed on men and women and for ages older and younger than the mean age of 62 years. Results For colorectal carcinoma and colonic adenomas the areas under the curve were 0.79 (95% confidence interval 0.71–0.87) and 0.60 (95% confidence interval 0.54–0.65), respectively. The positive predictive value of a positive FIT result for any neoplasia was 53%. The overall performance of the test for all neoplasia was better for men and better for older individuals. Conclusions The performance of FIT in this clinical setting was very good for detecting carcinoma, but marginal for detection of colonic adenomas.

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