tetano
Editor, Senior Moderator
Intern Emerg Med
. 2020 Sep 27.
doi: 10.1007/s11739-020-02495-w. Online ahead of print.
Cardiac injury and mortality in patients with Coronavirus disease 2019 (COVID-19): insights from a mediation analysis
Alberto Cipriani[SUP] 1 2 [/SUP], Federico Capone[SUP] 3 4 [/SUP], Filippo Donato[SUP] 5 4 [/SUP], Leonardo Molinari[SUP] 3 4 [/SUP], Davide Ceccato[SUP] 3 4 [/SUP], Alois Saller[SUP] 3 4 [/SUP], Lorenzo Previato[SUP] 3 4 [/SUP], Raffaele Pesavento[SUP] 3 4 [/SUP], Cristiano Sarais[SUP] 5 4 [/SUP], Paola Fioretto[SUP] 3 4 [/SUP], Sabino Iliceto[SUP] 5 4 [/SUP], Dario Gregori[SUP] 5 4 [/SUP], Angelo Avogaro[SUP] 3 4 [/SUP], Roberto Vettor[SUP] 3 4 [/SUP]
Affiliations
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.
Keywords: COVID-19; Cardiac injury; Cardiac troponin; Coronavirus 2019.
. 2020 Sep 27.
doi: 10.1007/s11739-020-02495-w. Online ahead of print.
Cardiac injury and mortality in patients with Coronavirus disease 2019 (COVID-19): insights from a mediation analysis
Alberto Cipriani[SUP] 1 2 [/SUP], Federico Capone[SUP] 3 4 [/SUP], Filippo Donato[SUP] 5 4 [/SUP], Leonardo Molinari[SUP] 3 4 [/SUP], Davide Ceccato[SUP] 3 4 [/SUP], Alois Saller[SUP] 3 4 [/SUP], Lorenzo Previato[SUP] 3 4 [/SUP], Raffaele Pesavento[SUP] 3 4 [/SUP], Cristiano Sarais[SUP] 5 4 [/SUP], Paola Fioretto[SUP] 3 4 [/SUP], Sabino Iliceto[SUP] 5 4 [/SUP], Dario Gregori[SUP] 5 4 [/SUP], Angelo Avogaro[SUP] 3 4 [/SUP], Roberto Vettor[SUP] 3 4 [/SUP]
Affiliations
- PMID: 32984929
- DOI: 10.1007/s11739-020-02495-w
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.
Keywords: COVID-19; Cardiac injury; Cardiac troponin; Coronavirus 2019.