Prognostic impact of high sensitive troponin in predicting 30-day mortality among patients admitted to hospital with influenza

Abstract

Background Worldwide, seasonal influenza causes significant mortality and severe infections may cause cardiac injury. High-sensitive-troponins (hsTnT) are sensitive and specific markers of myocardial damage. This study investigated the prognostic impact of hsTnT on 30-day mortality in hospitalised influenza patients. Methods This retrospective study included influenza patients ≥ 18 years, who had hsTnT performed during admission in two tertiary-hospitals in South Australia. Diagnosis of influenza was confirmed by polymerase–chain-reaction (PCR) test and hsTnT > 14 ng/L with a change of > 20% during admission was considered to be indicative of acute-cardiac injury. Clinical characteristics, complications and 30-day mortality were compared among four groups of patients: hsTnT unavailable, hsTnT negative, chronically elevated hsTnT and acutely elevated hsTnT. Cox-proportional hazard regression determined the hazard of death at 30-days following hospital discharge after adjustment for co-variates. Results Between January 2016 -March 2020, 1828 influenza patients, mean age 66.4 years, were hospitalised. Troponin results were available for 617 (47.7%) patients, of whom, 62 (10%) had acute myocardial injury and 232 (37.6%) had chronic hsTnT elevation. Both inpatient and 30-day mortality were significantly higher among patients with acute (P < 0.001) and chronic hsTnT (P < 0.001) when compared to other groups. When compared to patients with negative hsTnT, acute but not chronic hsTnT elevation was significantly associated with 30-day mortality after adjustment for various co-variates (HR 8.30, 1.80–17.84, P value = 0.013). Conclusions This is the largest available analysis of cardiac-specific biomarker hsTnT in patients with influenza. An acutely elevated hsTnT was associated with 30-day mortality among hospitalised influenza patients.

Prevalence and prognostic implications of myocardial injury in patients with influenza

“…In this prospective cohort study assessing the prevalence and prognostic value of elevated hs-cTnI in an unselected population of patients with laboratory-confirmed influenza infection patients were included during three influenza seasons. The prevalence of elevated hs-cTnI in our cohort of 181 patients with documented influenza was 6%, much lower than in two recent retrospective studies, which found that the prevalence rates of elevated hs-cTn in patients with influenza were 31.8, 23 47.7, 25 and 65.5%. 24 However, unlike the present prospective study, the two previous retrospective reports calculated the prevalence of elevated hs-cTn in selected individuals in whom hs-cTn had been measured, thus increasing the likelihood of inclusion bias.…”

“…By contrast, the median age of the patients in the previous studies was between 66 and 80 years, and a large proportion of patients had been admitted to hospital, implying more severe disease. 24 , 25 Additionally, in the recent prospective study 12.4% were admitted to the intensive care unit. 24 The prevalence rates of elevated hs-cTn patients aged ≥65 years in those admitted to hospital in the present study, however, were 10 and 14%, respectively.…”

Dexamethasone Improves Cardiovascular Outcomes in Critically Ill COVID-19, a Real World Scenario Multicenter Analysis

“…Accordingly, in addition to their reflection of cardiac injury, troponin levels were also reported to be of prognostic relevance in the presence of sepsis ( 28 – 30 ). Additionally, recent studies demonstrated an increased risk for cardiac complications and fatal outcomes in the presence of elevated troponin levels in influenza patients, with a significant impact on 30-day mortality rates ( 31 , 32 ). In the present study, a significant difference in troponin levels was already evident at the first day after admittance to ICU.…”

Acute coronary syndrome in COVID-19 patients

“…Клиническое течение ОКС Наряду с COVID-19 приводимые в литературе данные исследований течения вирусных инфекций прошлых лет подтверждают высокие риски ССО. Так, вирус гриппа значительно увеличивал риски развития ОКС и внезапной сердечной смерти как в раннем, так и в отсроченном периоде течения болезни [39][40][41]. Результаты исследования 133562 случаев ИМ в период эпидемии сезонным гриппом показали более высокую частоту ИМ в периоды с наибольшим количеством зарегистрированных случаев гриппа.…”