Is it all in the heart? Myocardial injury as major predictor of mortality among hospitalized COVID‐19 patients

Harmouch, Farah; Shah, Kashyap; Hippen, John T.; Kumar, Ashish; Goel, Harsh

doi:10.1002/jmv.26347

Cited by 23 publications

(27 citation statements)

References 29 publications

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“…In accordance with previous evidence, our results on the association of higher D-dimer with disease progression in COVID-19 support that severe patients are at higher risk of hypercoagulability 34 , 38 , 97 , 98 . Also, a large body of evidence shows that, the non-surviving COVID-19 exhibit significantly higher D-dimer levels, reflective of hypercoagulability status 4 , 5 , 13 – 15 , 64 – 66 .…”

Section: Discussionsupporting

confidence: 93%

D-dimer, disease severity, and deaths (3D-study) in patients with COVID-19: a systematic review and meta-analysis of 100 studies

Varikasuvu

Varshney

Dutt

et al. 2021

Sci Rep

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Hypercoagulability and the need for prioritizing coagulation markers for prognostic abilities have been highlighted in COVID-19. We aimed to quantify the associations of D-dimer with disease progression in patients with COVID-19. This systematic review and meta-analysis was registered with PROSPERO, CRD42020186661.We included 113 studies in our systematic review, of which 100 records (n = 38,310) with D-dimer data) were considered for meta-analysis. Across 68 unadjusted (n = 26,960) and 39 adjusted studies (n = 15,653) reporting initial D-dimer, a significant association was found in patients with higher D-dimer for the risk of overall disease progression (unadjusted odds ratio (uOR) 3.15; adjusted odds ratio (aOR) 1.64). The time-to-event outcomes were pooled across 19 unadjusted (n = 9743) and 21 adjusted studies (n = 13,287); a strong association was found in patients with higher D-dimers for the risk of overall disease progression (unadjusted hazard ratio (uHR) 1.41; adjusted hazard ratio (aHR) 1.10). The prognostic use of higher D-dimer was found to be promising for predicting overall disease progression (studies 68, area under curve 0.75) in COVID-19. Our study showed that higher D-dimer levels provide prognostic information useful for clinicians to early assess COVID-19 patients at risk for disease progression and mortality outcomes. This study, recommends rapid assessment of D-dimer for predicting adverse outcomes in COVID-19.

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Section: Discussionsupporting

confidence: 93%

D-dimer, disease severity, and deaths (3D-study) in patients with COVID-19: a systematic review and meta-analysis of 100 studies

Varikasuvu

Varshney

Dutt

et al. 2021

Sci Rep

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“…The all-cause mortality rate in our study was 14%, which is similar to the rates in many published studies [ 2 , [5] , [6] , [7] , [8] , [9] , [10] , [11] ]. Multiple studies have shown that elevated troponin is an independent prognostic factor in patients hospitalized due to COVID-19 [ 2 , [5] , [6] , [7] , 39 ].…”

Section: Discussionsupporting

confidence: 91%

“…Proposed mechanisms include vascular endothelial activation/inflammation, microvascular injury, direct myocardial inflammation and injury, thromboembolic events, and exacerbation of underlying cardiovascular conditions in the context of hypoxemia and release of excess endogenous catecholamines [ 3 ]. Cardiovascular events in patients with COVID-19 are associated with worse outcomes [ 2 , 4 , 5 ]. Previous reports have shown that patients who present with clinical evidence of myocardial injury in the context of COVID-19 are at 1.5- to 4.5-fold greater risk of dying compared to patients without myocardial injury [ 2 , [5] , [6] , [7] , [8] , [9] , [10] , [11] ].…”

Section: Introductionmentioning

confidence: 99%

“…Cardiovascular events in patients with COVID-19 are associated with worse outcomes [ 2 , 4 , 5 ]. Previous reports have shown that patients who present with clinical evidence of myocardial injury in the context of COVID-19 are at 1.5- to 4.5-fold greater risk of dying compared to patients without myocardial injury [ 2 , [5] , [6] , [7] , [8] , [9] , [10] , [11] ]. Variability in the reported impact of myocardial injury on mortality in patients with COVID-19 has been attributed to the small sample sizes and differences in the definitions of a cardiovascular events (e.g., cardiac biomarker elevation versus imaging studies) in reported studies to date [ 2 , 4 , 6 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Distinct etiologies of high-sensitivity troponin T elevation predict different mortality risks for patients hospitalized with COVID-19

Khaloo¹,

Shaqdan²,

Ledesma³

et al. 2022

International Journal of Cardiology

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Background Cardiovascular events in the context of COVID-19 infection increase the risk of negative patient outcomes, but large cohort studies describing this association are limited. The purpose of the current study was to investigate the potential associations between cardiovascular events and mortality in patients hospitalized due to COVID-19. Methods A retrospective chart review was performed in 2450 patients hospitalized for confirmed COVID-19 infection within a single hospital network between March 15 and June 15, 2020. Logistic regression analysis was used to identify predictors of mortality. Results In the study population, 57% of patients had elevated high sensitivity troponin (hs-TnT) levels. Acute heart failure occurred in 23% of patients and arrhythmias were observed in 8% of patients. Of the 1401 patients with elevated hs-TnT levels, a primary cardiac etiology (e.g., myocardial infarction) was identified in 653 (47%) patients. In the remaining 748 (53%) patients, there was evidence of a primary non-cardiac etiology for hs-TnT elevation such as renal failure ( n = 304) and critical illness ( n = 286). Elevated hs-TnT was associated with increased risk of mortality. A significantly higher mortality rate was observed for hs-TnT elevation associated with a primary cardiac etiology (OR 4.6, 95% CI: 2.7–7.6; P < 0.001) than a primary non-cardiac etiology (OR 2.7, 95% CI: 1.6–4.5; P < 0.001). Conclusions Elevated hs-TnT in the context of COVID-19 infection is associated with a significantly increased mortality risk. Hs-TnT elevation in the context of a primary cardiac etiology confers a nearly 2-fold higher mortality risk than hs-TnT elevation due to a primary non-cardiac etiology.

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“…In total, this systematic review and meta-analysis included 12,262 patients from 13 studies (Figure 1) (Al Abbasi et al, 2020;Arcari et al, 2020;Connor-Schuler et al, 2020;Du et al, 2020;Heron and Chiu, 2020;Li et al, 2020;Lombardi et al, 2020;Maeda et al, 2020;Raad et al, 2020;Shah et al, 2020;Harmouch et…”

Section: Resultsmentioning

confidence: 99%

Prognostic performance of troponin in COVID-19: A diagnostic meta-analysis and meta-regression

Wibowo

Pranata

Akbar

et al. 2021

International Journal of Infectious Diseases

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Background Cardiac injury is frequently encountered in patients with COVID-19 and is associated with an increased risk of mortality. Elevated troponin may signify myocardial damage and predicts mortality. We aimed to assess the prognostic value of elevated troponin above the 99 th percentile upper reference limit (URL) on mortality and factors affecting their relationship. Methods We performed a comprehensive literature search using PubMed (MEDLINE), Scopus, and Embase from inception of the search databases until 16 th December 2020. The key exposure was elevated serum troponin, defined as troponin (of any type) elevation > 99th percentile URL. The outcome was mortality due to any causes. Results There were a total of 12,262 patients from 13 studies in this systematic review and meta-analysis. Mortality was present in 23% (20-26%) of the patients. Elevated troponin was present in 31% (23-38%) of the patients. Elevated troponin was associated with increased mortality (OR 4.75 [4.07, 5.53], p < 0.001; I 2 : 19.9%). Meta-regression shows that the association did not vary with age (p = 0.218), male gender (p = 0.707), hypertension (p = 0.182), diabetes (p = 0.906), and coronary artery disease (p = 0864). Elevated troponin was associated with sensitivity of 0.55 [0.44, 0.66], specificity of 0.80 [0.71, 0.86], PLR 2.7 of [2.2, 3.3], NLR of 0.56 [0.49, 0.65], DOR of 5 [4, 5], and AUC of 0.73 [0.69, 0.77]. Elevated troponin resulted in a 45% probability for mortality and non-elevated troponin resulted in a 14% probability for mortality. Conclusion Elevated troponin was associated with increased mortality with a 55% sensitivity and 80% specificity.

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Is it all in the heart? Myocardial injury as major predictor of mortality among hospitalized COVID‐19 patients

Cited by 23 publications

References 29 publications

D-dimer, disease severity, and deaths (3D-study) in patients with COVID-19: a systematic review and meta-analysis of 100 studies

D-dimer, disease severity, and deaths (3D-study) in patients with COVID-19: a systematic review and meta-analysis of 100 studies

Distinct etiologies of high-sensitivity troponin T elevation predict different mortality risks for patients hospitalized with COVID-19

Prognostic performance of troponin in COVID-19: A diagnostic meta-analysis and meta-regression

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