The prognostic value of myocardial injury in COVID‐19 patients and associated characteristics

Abstract

Background Since December 2019, coronavirus disease 2019 (COVID‐19) has emerged as an international pandemic. COVID‐19 patients with myocardial injury might need special attention. However, an understanding on this aspect remains unclear. This study aimed to illustrate clinical characteristics and the prognostic value of myocardial injury to COVID‐19 patients. Methods This retrospective, single‐center study finally included 304 hospitalized COVID‐19 cases confirmed by real‐time reverse‐transcriptase polymerase chain reaction from January 11 to March 25, 2020. Myocardial injury was determined by serum high‐sensitivity troponin I (Hs‐TnI). The primary endpoint was COVID‐19‐associated mortality. Results Of 304 COVID‐19 patients (median age, 65 years; 52.6% males), 88 patients (27.3%) died (61 patients with myocardial injury, 27 patients without myocardial injury on admission). COVID‐19 patients with myocardial injury had more comorbidities (hypertension, chronic obstructive pulmonary disease, cardiovascular disease, and cerebrovascular disease); lower lymphocyte counts, higher C‐reactive protein (CRP; median, 84.9 vs. 28.5 mg/L; p < .001), procalcitonin levels (median, 0.29 vs. 0.06 ng/ml; p < .001), inflammatory and immune response markers; more frequent need for noninvasive ventilation, invasive mechanical ventilation; and was associated with higher mortality incidence (hazard ratio [HR] = 7.02; 95% confidence interval [CI], 4.45–11.08; p < .001) than those without myocardial injury. Myocardial injury (HR = 4.55; 95% CI, 2.49–8.31; p < .001), senior age, CRP levels, and novel coronavirus pneumonia types on admission were independent predictors to mortality in COVID‐19 patients. Conclusions COVID‐19 patients with myocardial injury on admission is associated with more severe clinical presentation and biomarkers. Myocardial injury and higher Hs‐TnI are both strongest independent predictors to COVID‐19‐related mortality after adjusting confounding factors.

Cardiovascular System during SARS-CoV-2 Infection

“…Nonetheless, there is a possibility that cardiovascular complications can be more severe for SARS-CoV-2 than other viruses, such as the influenza virus, mentioned before [63], and further research is needed to confirm this hypothesis. It is not a surprise that mortality is higher in patients with cardiac injury and/or elevated troponin levels comparing groups of COVID-19-positive patients with and without cardiac injury [7,9,10,15,16,32] but also those who are older [7,11,16,22,26], male [10,16,22] or have a more severe disease [7,22]. SARS-CoV-2-infected patients with more comorbidities are more likely to have cardiac injury [22,26].…”

“…It is not a surprise that mortality is higher in patients with cardiac injury and/or elevated troponin levels comparing groups of COVID-19-positive patients with and without cardiac injury [7,9,10,15,16,32] but also those who are older [7,11,16,22,26], male [10,16,22] or have a more severe disease [7,22]. SARS-CoV-2-infected patients with more comorbidities are more likely to have cardiac injury [22,26]. The fact that cardiac injury [21,22], as well as elevated biomarkers [7,8,18,19,[28][29][30][31][32], are an independent risk factor for mortality in patients infected with SARS-CoV-2 is crucial.…”

“…SARS-CoV-2-infected patients with more comorbidities are more likely to have cardiac injury [22,26]. The fact that cardiac injury [21,22], as well as elevated biomarkers [7,8,18,19,[28][29][30][31][32], are an independent risk factor for mortality in patients infected with SARS-CoV-2 is crucial. One of the works showed that cTnI is a better short-term morality marker than LDH, CRP or D-Dimers [31].…”

“…Compared with those without myocardial injury, more COVID-19-positive patients with myocardial injury required oxygen inhalation, non-invasive ventilation, invasive mechanical ventilation, antibiotic treatment and hemoperfusion therapy (all p < 0.001). Mortality rate was significantly higher in patients with myocardial injury (63.5% vs. 13.0%, p < 0.001) [22]. A study of 400 COVID-19-positive patients in this section show that those with cardiac injury (troponin >99 th percentile) were older (52.5 (42.8-68.0) vs. 49.0 (36.0-0.0) years), myocardial injury event was much higher in patients with comorbidities: hypertension (12/46 (26.1%) vs. 50/354 (14.1%)), hyperlipidemia (4/46 (8.7%) vs. 7/354 (2.0%)) and chronic kidney insufficiency (3/46 (6.5%) vs. 2/354 (0.6%)) [26].…”

“…Cardiac injury was a crucial and independent risk factor for mortality in COVID-19-infected patients [12,[21][22][23] and mortality was usually higher in the cardiac injury group [7,9,[23][24][25]. Patients with cardiac injury were older [7,11,22,26], had more comorbidities [22,25,26], were mostly male [10,22], had more serious disease [7,22,23] or were more likely to require mechanical ventilation [21,22]. Age is an independent predictor of myocardial injury in COVID-19-positive patients [10].…”