Using high sensitivity cardiac troponin values in patients with SARS-CoV-2 infection (COVID-19): The Padova experience

Michieli, Laura De; Babuin, Luciano; Vigolo, Simonetta; Marinis, Giulia Berti de; Lunardon, Alessandro; Favretto, Francesco; Lobo, Ronstan; Sandoval, Yader; Bryant, Sandra C.; Donato, Daniele; Plebani, Mario; Vettor, Roberto; Iliceto, Sabino; Cianci, Vito; Jaffe, Allan S.

doi:10.1016/j.clinbiochem.2021.01.006

Cited by 18 publications

(23 citation statements)

References 34 publications

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“…Zhou et al demonstrated that a cutoff of 28 ng/L for high sensitivity TnI was associated with significant in-hospital mortality with an odds ratio of 80 (95% CI: 10-620) [23] . In addition, De Michieli et al demonstrated that a single overall cutoff of high sensitivity TnI of 26 ng/L was associated with death with an overall area under the curve of 0.811, and the authors also concluded that peak high sensitivity TnI concentration was not more informative than the initial value [26] , similar to our observation. Interpretation of cardiac troponin levels in COVID-19 patients must be done with caution as some studies are based on TnT and others on TnI, some are based on high sensitivity assays while others are not, and some of the available literature does not report the manufacturer of the assay or the 99 th percentile of the URL, thus making extrapolation and interpretation of data difficult [25] .…”

Section: Discussionsupporting

confidence: 87%

Biochemistry tests in hospitalized COVID-19 patients: Experience from a Canadian tertiary care centre

Rutledge

Choi

Karp

et al. 2021

Clinical Biochemistry

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Background Coronavirus Disease 2019 (COVID-19) has variable clinical presentation, from asymptomatic to severe disease leading to death. Biochemical markers may help with management and prognostication of COVID-19 patients; however, their utility is still under investigation. Methods A retrospective study was conducted to evaluate alanine aminotransferase, C-reactive protein (CRP), ferritin, lactate, and high sensitivity troponin T (TnT) levels in 67 patients who were admitted to a Canadian tertiary care centre for management of COVID-19. Logistic, cause-specific Cox proportional-hazards, and accelerated failure-time regression modelling were performed to assess the associations of initial analyte concentrations with in-hospital death and length of stay in hospital; joint modelling was performed to assess the associations of the concentrations over the course of the hospital stay with in-hospital death. Results Initial TnT and CRP concentrations were associated with length of stay in hospital. Eighteen patients died (27%), and the median initial TnT concentration was higher in patients who died (55 ng/L) than those who lived (16 ng/L; P <0.0001). There were no survivors with an initial TnT concentration >64 ng/L. While the initial TnT concentration was predictive of death, later measurements were not. Only CRP had prognostic value with both the initial and subsequent measurements: a 20% increase in the initial CRP concentration was associated with a 14% (95% confidence interval (CI): 1-29%) increase in the odds of death, and the hazard of death increased 14% (95% CI: 5-25%) for each 20% increase in the current CRP value. While the initial lactate concentration was not predictive of death, subsequent measurements were. Conclusion CRP, lactate and TnT were associated with poorer outcomes and appear to be useful biochemical markers for monitoring COVID-19 patients.

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Section: Discussionsupporting

confidence: 87%

Biochemistry tests in hospitalized COVID-19 patients: Experience from a Canadian tertiary care centre

Rutledge

Choi

Karp

et al. 2021

Clinical Biochemistry

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“…One study showed that 41 (22%) of admitted patients had myocardial injury and the mortality was similar among those with myocardial injury regardless of whether they had or did not have COVID-19 infection [47]. The included studies also examined the relationship between troponin level and mortality or the prevalence of elevated cardiac enzymes among hospitalized COVID-19 patients [35,39,41,44,51,52,54,58,61,66].…”

Section: N Resultsmentioning

confidence: 99%

Myocardial injuries among patients with COVID-19: a systematic review

Alali¹,

Smaisem²,

Alsheikh³

et al. 2021

Infez Med

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This is a systematic review of the literature specifically aimed to explore myocardial injury in coronavirus disease-19 (COVID-19) patients who were hospitalized with severe complicated infections. The medical literature was examined through the large medical databases, including Medline, Ovid, PubMed, and Embase, over the last year between January 2020 and May 2021. The search terms used were a combination of ''myocardial injury'' AND ''COVID-19'' AND "Hospitalization". Then we applied a step to filter the results to select original research articles only evaluating the myocardial injuries in severe COVID-19 hospitalized patients. Selected trials mentioned the type of myocardial injury detected with the infection. A total of 245 articles were extracted. Considering the exclusion of ineligible articles, 42 articles appeared. A total of 42 articles were eligible and were included SUMMARY in the review. These studies included a total of 4326 COVID-19 patients. The 30-day mortality was found to be associated with increased cardiac troponin and myocardial infarction could be a systemic reaction rather than the direct action of COVID-19. Patients with myocardial injury were significantly older and with co-morbid conditions. Studies also found a correlation of higher concentrations of cardiac enzymes with disease severity and increased in-hospital mortality. Myocardial injury was a significant predictor for severe COVID-19 infection and in-hospital mortality. Cardiac enzymes should be monitored in hospitalized patients with severe COVID-19 infections.

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“…A number of investigators have shown the potential value of a range of cardiac biomarkers, including high sensitivity troponins (Tn; TnT and TnI), creatinine kinase isoenzyme-MB (CK-MB) and N-terminal pro-brain-type natriuretic peptide (BNP; NT-proBNP), either as early indicators of cardiac involvement in COVID-19 infections and/or as markers of disease prognosis (27)(28)(29)(30)(31)(32)(33)(34), while measurement of D-dimers is thought to be potentially important in preventing, diagnosing and managing vascular complications (24).…”

Section: The Clinical Aspects Of Covid-19 and Cardiovascular Diseasementioning

confidence: 99%

Emerging Role of Platelet-Endothelium Interactions in the Pathogenesis of Severe SARS-CoV-2 Infection-Associated Myocardial Injury

et al. 2022

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Cardiovascular dysfunction and disease are common and frequently fatal complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Indeed, from early on during the SARS-CoV-2 virus pandemic it was recognized that cardiac complications may occur, even in patients with no underlying cardiac disorders, as part of the acute infection, and that these were associated with more severe disease and increased morbidity and mortality. The most common cardiac complication is acute cardiac injury, defined by significant elevation of cardiac troponins. The potential mechanisms of cardiovascular complications include direct viral myocardial injury, systemic inflammation induced by the virus, sepsis, arrhythmia, myocardial oxygen supply-demand mismatch, electrolyte abnormalities, and hypercoagulability. This review is focused on the prevalence, risk factors and clinical course of COVID-19-related myocardial injury, as well as on current data with regard to disease pathogenesis, specifically the interaction of platelets with the vascular endothelium. The latter section includes consideration of the role of SARS-CoV-2 proteins in triggering development of a generalized endotheliitis that, in turn, drives intense activation of platelets. Most prominently, SARS-CoV-2–induced endotheliitis involves interaction of the viral spike protein with endothelial angiotensin-converting enzyme 2 (ACE2) together with alternative mechanisms that involve the nucleocapsid and viroporin. In addition, the mechanisms by which activated platelets intensify endothelial activation and dysfunction, seemingly driven by release of the platelet-derived calcium-binding proteins, SA100A8 and SA100A9, are described. These events create a SARS-CoV-2–driven cycle of intravascular inflammation and coagulation, which contributes significantly to a poor clinical outcome in patients with severe disease.

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Using high sensitivity cardiac troponin values in patients with SARS-CoV-2 infection (COVID-19): The Padova experience

Cited by 18 publications

References 34 publications

Biochemistry tests in hospitalized COVID-19 patients: Experience from a Canadian tertiary care centre

Biochemistry tests in hospitalized COVID-19 patients: Experience from a Canadian tertiary care centre

Myocardial injuries among patients with COVID-19: a systematic review

Emerging Role of Platelet-Endothelium Interactions in the Pathogenesis of Severe SARS-CoV-2 Infection-Associated Myocardial Injury

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