open access

Vol 27, No 5 (2020)
Original article — COVID-19
Published online: 2020-06-26
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Myocardial injury determination improves risk stratification and predicts mortality in COVID-19 patients

Alvaro Lorente-Ros, Juan Manuel Monteagudo Ruiz, Luis M. Rincón, Rodrigo Ortega Pérez, Sonia Rivas, Rafael Martínez-Moya, Maria Ascensión Sanromán, Luis Manzano, Gonzalo Luis Alonso, Borja Ibáñez, Jose Luis Zamorano
DOI: 10.5603/CJ.a2020.0089
·
Pubmed: 32589258
·
Cardiol J 2020;27(5):489-496.

open access

Vol 27, No 5 (2020)
Original article — COVID-19
Published online: 2020-06-26

Abstract

Background: Despite being associated with worse prognosis in patients with COVID-19, systematic determination of myocardial injury is not recommended. The aim of the study was to study the effect of myocardial injury assessment on risk stratification of COVID-19 patients.

Methods: Seven hundred seven consecutive adult patients admitted to a large tertiary hospital with confirmed COVID-19 were included. Demographic data, comorbidities, laboratory results and clinical outcomes were recorded. Charlson comorbidity index (CCI) was calculated in order to quantify the degree of comorbidities. Independent association of cardiac troponin I (cTnI) increase with outcomes was evaluated by multivariate regression analyses and area under curve. In addition, propensity-score matching was performed to assemble a cohort of patients with similar baseline characteristics.

Results: In the matched cohort (mean age 66.76 ± 15.7 years, 37.3% females), cTnI increase above the upper limit was present in 20.9% of the population and was associated with worse clinical outcomes, including all-cause mortality within 30 days (45.1% vs. 23.2%; p = 0.005). The addition of cTnI to a multivariate prediction model showed a significant improvement in the area under the time-dependent receiver operating characteristic curve (0.775 vs. 0.756, DC-statistic = 0.019; 95% confidence interval 0.001–0.037). Use of renin–angiotensin–aldosterone system inhibitors was not associated with mortality after adjusting by baseline risk factors.

Conclusions: Myocardial injury is independently associated with adverse outcomes irrespective of baseline comorbidities and its addition to multivariate regression models significantly improves their performance in predicting mortality. The determination of myocardial injury biomarkers on hospital admission and its combination with CCI can classify patients in three risk groups (high, intermediate and low) with a clearly distinct 30-day mortality.

Abstract

Background: Despite being associated with worse prognosis in patients with COVID-19, systematic determination of myocardial injury is not recommended. The aim of the study was to study the effect of myocardial injury assessment on risk stratification of COVID-19 patients.

Methods: Seven hundred seven consecutive adult patients admitted to a large tertiary hospital with confirmed COVID-19 were included. Demographic data, comorbidities, laboratory results and clinical outcomes were recorded. Charlson comorbidity index (CCI) was calculated in order to quantify the degree of comorbidities. Independent association of cardiac troponin I (cTnI) increase with outcomes was evaluated by multivariate regression analyses and area under curve. In addition, propensity-score matching was performed to assemble a cohort of patients with similar baseline characteristics.

Results: In the matched cohort (mean age 66.76 ± 15.7 years, 37.3% females), cTnI increase above the upper limit was present in 20.9% of the population and was associated with worse clinical outcomes, including all-cause mortality within 30 days (45.1% vs. 23.2%; p = 0.005). The addition of cTnI to a multivariate prediction model showed a significant improvement in the area under the time-dependent receiver operating characteristic curve (0.775 vs. 0.756, DC-statistic = 0.019; 95% confidence interval 0.001–0.037). Use of renin–angiotensin–aldosterone system inhibitors was not associated with mortality after adjusting by baseline risk factors.

Conclusions: Myocardial injury is independently associated with adverse outcomes irrespective of baseline comorbidities and its addition to multivariate regression models significantly improves their performance in predicting mortality. The determination of myocardial injury biomarkers on hospital admission and its combination with CCI can classify patients in three risk groups (high, intermediate and low) with a clearly distinct 30-day mortality.

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Keywords

cardiac injury, myocardial injury, troponin, coronavirus, COVID-19, cardiovascular disease

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About this article
Title

Myocardial injury determination improves risk stratification and predicts mortality in COVID-19 patients

Journal

Cardiology Journal

Issue

Vol 27, No 5 (2020)

Pages

489-496

Published online

2020-06-26

DOI

10.5603/CJ.a2020.0089

Pubmed

32589258

Bibliographic record

Cardiol J 2020;27(5):489-496.

Keywords

cardiac injury
myocardial injury
troponin
coronavirus
COVID-19
cardiovascular disease

Authors

Alvaro Lorente-Ros
Juan Manuel Monteagudo Ruiz
Luis M. Rincón
Rodrigo Ortega Pérez
Sonia Rivas
Rafael Martínez-Moya
Maria Ascensión Sanromán
Luis Manzano
Gonzalo Luis Alonso
Borja Ibáñez
Jose Luis Zamorano

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