Research Article
High-sensitivity cardiac troponin I and D-dimer are risk factors for in-hospital mortality of adult patients with COVID-19: A retrospective cohort study
Abstract
Aim: This study aimed to evaluate the impact of high-sensitivity cardiac troponin I (Hs-cTnI) and D-dimer on in-hospital mortality of adult patients with Coronavirus disease 2019 (COVID-19). Materials and Methods: The COVID-19 outbreak, a global health disaster, has resulted in significant morbidity and mortality around the world since it emerged in December 2019. The outbreak has gradually spread nationwide. COVID-19 is associated with hemostatic abnormalities and cardiac injury. This retrospective cohort study included a total of 221 adult inpatients. The diagnosis of COVID-19 was made according to the World Health Organization's interim guideline and confirmed by RNA detection of SARS-CoV-2. Participants were divided into 2 groups, survivors and non-survivors.
Results: Hs-cTnI and D-dimer levels on admission were significantly higher in non-survivors COVID-19 patients (p<0.05 for each). Forward stepwise logistic regression analysis demonstrated that age (OR=1.140, 95% CI: 1.045-1.244, p=0.003), baseline hs-cTnI level (OR=1.022, 95% CI: 1.004-1.041, p=0.018), and baseline D-dimer level (OR=1.790, 95% CI: 1.078-2.972, p=0.024) were independent predictors of in-hospital mortality of adult patients with COVID-19. The receiver operating characteristic curve analysis provided a cut-off value of >18.6 ng/L for hs-cTnI to predict in-hospital mortality of adult patients with COVID-19 with 100% sensitivity and 74% specificity, and a cut-off value of > 1.41 mg/L for D-dimer with 93.3% sensitivity and 71.5% specificity.
Conclusion: High-sensitivity cardiac troponin I and D-dimer levels on admission predict in-hospital mortality of adult patients with COVID-19.
Keywords
References
- Zhu N, Zhang D, Wang W, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med 2020; 382 (8): 727-33.
- Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395 (10223): 497-506.
- Hendren NS, Drazner MH, Bozkurt B, Cooper LT, Jr. Description and Proposed Management of the Acute COVID-19 Cardiovascular Syndrome. Circulation2020.
- Deng Q, Hu B, Zhang Y, et al. Suspected myocardial injury in patients with COVID-19: Evidence from front-line clinical observation in Wuhan, China. Int J Cardiol 2020.
- Ammirati E, Wang DW. SARS-CoV-2 inflames the heart. The importance of awareness of myocardial injury in COVID-19 patients. Int J Cardiol 2020.
- Kochi AN, Tagliari AP, Forleo GB, Fassini GM, Tondo C. Cardiac and arrhythmic complications in patients with COVID-19. J Cardiovasc Electrophysiol 2020.
- Mishra AK, Sahu KK, Lal A, Sargent J. Patterns of heart Injury in COVID - 19 and relation to outcome. J Med Virol 2020.
- Klok FA, Kruip M, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 2020.
- Milbrandt EB, Reade MC, Lee M, et al. Prevalence and significance of coagulation abnormalities in community-acquired pneumonia. Mol Med 2009; 15 (11-12): 438-45.
- Corrales-Medina VF, Musher DM, Shachkina S, Chirinos JA. Acute pneumonia and the cardiovascular system. Lancet 2013; 381 (9865): 496-505.
- Udell JA, Zawi R, Bhatt DL, et al. Association between influenza vaccination and cardiovascular outcomes in high-risk patients: a meta-analysis. JAMA 2013; 310 (16):1711-20.
- Blackburn R, Zhao H, Pebody R, Hayward A, Warren-Gash C. Laboratory-Confirmed Respiratory Infections as Predictors of Hospital Admission for Myocardial Infarction and Stroke: Time-Series Analysis of English Data for 2004-2015. Clin Infect Dis 2018; 67 (1): 8-17.
- Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020; 18 (4):844-47.
- Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395 (10229):1054-62.
- Choi KW, Chau TN, Tsang O, et al. Outcomes and prognostic factors in 267 patients with severe acute respiratory syndrome in Hong Kong. Ann Intern Med 2003; 139 (9): 715-23.
- Choi WS, Kang CI, Kim Y, et al. Clinical Presentation and Outcomes of Middle East Respiratory Syndrome in the Republic of Korea. Infect Chemother 2016; 48 (2):118-26.
- Kim SW, Park JW, Jung HD, et al. Risk factors for transmission of Middle East respiratory syndrome coronavirus infection during the 2015 outbreak in South Korea. Clin Infect Dis 2017; 64 (5): 551-57.
- Sherbini N, Iskandrani A, Kharaba A, Khalid G, Abduljawad M, Al-Jahdali H. Middle East respiratory syndrome coronavirus in Al-Madinah City, Saudi Arabia: Demographic, clinical and survival data. J Epidemiol Glob Health 2017; 7 (1): 29-36.
- Park JE, Jung S, Kim A, Park JE. MERS transmission and risk factors: a systematic review. BMC Public Health 2018; 18 (1): 574.
- Zheng Z, Peng F, Xu B, et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. J Infect 2020.
- Du RH, Liang LR, Yang CQ, et al. Predictors of Mortality for Patients with COVID-19 Pneumonia Caused by SARS-CoV-2: A Prospective Cohort Study. Eur Respir J 2020.
- Licastro F, Candore G, Lio D, et al. Innate immunity and inflammation in ageing: a key for understanding age-related diseases. Immun Ageing 2005; 2:8.
- Plackett TP, Boehmer ED, Faunce DE, Kovacs EJ. Aging and innate immune cells. J Leukoc Biol2004; 76 (2): 291-99.
- Meyer KC. The role of immunity in susceptibility to respiratory infection in the aging lung. Respir Physiol2001; 128 (1):23-31.
- Smits SL, de Lang A, van den Brand JM, et al. Exacerbated innate host response to SARS-CoV in aged non-human primates. PLoS Pathog2010; 6 (2):e1000756.
- Opal SM, Girard TD, Ely EW. The immunopathogenesis of sepsis in elderly patients. Clin Infect Dis2005; 41 Suppl 7: S504-12.
- Corrales-Medina VF, Musher DM, Wells GA, Chirinos JA, Chen L, Fine MJ. Cardiac complications in patients with community-acquired pneumonia: incidence, timing, risk factors, and association with short-term mortality. Circulation 2012; 125 (6):773-81.
- 28. Violi F, Cangemi R, Falcone M, et al. Cardiovascular Complications and Short-term Mortality Risk in Community-Acquired Pneumonia. Clin Infect Dis 2017; 64 (11): 1486-93.
- Mandal P, Chalmers JD, Choudhury G, Akram AR, Hill AT. Vascular complications are associated with poor outcome in community-acquired pneumonia. QJM 2011; 104 (6): 489-95.
- Cangemi R, Calvieri C, Falcone M, et al. Relation of Cardiac Complications in the Early Phase of Community-Acquired Pneumonia to Long-Term Mortality and Cardiovascular Events. Am J Cardiol 2015; 116 (4): 647-51.
- Frencken JF, van Baal L, Kappen TH, et al. Myocardial Injury in Critically Ill Patients with Community-acquired Pneumonia. A Cohort Study. Ann Am Thorac Soc 2019; 16 (5): 606-12.
- Guo T, Fan Y, Chen M, et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol 2020.
- Tersalvi G, Vicenzi M, Calabretta D, Biasco L, Pedrazzini G, Winterton D. Elevated troponin in patients with Coronavirus Disease 2019 (COVID-19): possible mechanisms. J Card Fail 2020.
- Zhang L, Long Y, Xiao H, Yang J, Toulon P, Zhang Z. Use of D-dimer in oral anticoagulation therapy. Int J Lab Hematol 2018.
- Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020.
- Barrett CD, Moore HB, Yaffe MB, Moore EE. ISTH interim guidance on recognition and management of coagulopathy in COVID-19: A Comment. J Thromb Haemost 2020.
- Liu Q, Zhou YH, Yang ZQ. The cytokine storm of severe influenza and development of immunomodulatory therapy. Cell Mol Immunol 2016; 13 (1): 3-10.
- Wong JP, Viswanathan S, Wang M, Sun LQ, Clark GC, D'Elia RV. Current and future developments in the treatment of virus-induced hypercytokinemia. Future Med Chem 2017; 9 (2):169-178.
- Levi M, van der Poll T. Coagulation and sepsis. Thromb Res 2017; 149:38-44.
- Ninivaggi M, de Laat M, Lance MM, et al. Hypoxia Induces a Prothrombotic State Independently of the Physical Activity. PLoS One 2015; 10 (10): e0141797.
- Mari D, Mannucci PM, Coppola R, Bottasso B, Bauer KA, Rosenberg RD. Hypercoagulability in centenarians: the paradox of successful aging. Blood 1995; 85 (11): 3144-3149.
- Mari D, Ogliari G, Castaldi D, Vitale G, Bollini EM, Lio D. Hemostasis and ageing. Immun Ageing 2008; 5: 12.
- Iba T, Levy JH, Warkentin TE, et al. Diagnosis and management of sepsis-induced coagulopathy and disseminated intravascular coagulation. J Thromb Haemost 2019; 17 (11): 1989-1994.
- Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020.
- Zhang J, Wang X, Jia X, et al. Risk factors for disease severity, unimprovement, and mortality of COVID-19 patients in Wuhan, China. Clin Microbiol Infect 2020.
COVID-19 tanılı yetişkinlerde yüksek duyarlıklı kardiyak troponin I ve D-dimer hastane içi mortalite için risk faktörleridir: Retrospektif kohort çalışması
Abstract
Amaç: Bu çalışmada, yüksek duyarlıklı kardiyak troponin I (Hs-cTnI) ve D-dimerin, Koronavirus hastalığı 2019 (COVID-19) olan yetişkin hastaların hastane içi mortalite üzerine etkisinin değerlendirilmesi amaçlamıştır.
Gereç ve Yöntem: Küresel bir sağlık felaketi olan COVID-19 salgını, Aralık 2019'da ortaya çıktığından bu yana dünya çapında önemli morbidite ve mortaliteyle sonuçlanarak yavaş yavaş ülke çapında yayıldı. COVID-19 hemostatik anormallikler ve kardiyak hasar ile ilişkilidir. Bu retrospektif kohort çalışmasına toplam 221 yetişkin hasta dahil edilmiştir. COVID-19 tanısı, Dünya Sağlık Örgütü'nün geçici rehberlerine göre konuldu ve SARS-CoV-2' nin RNA tespiti ile doğrulandı. Hastalar sağ kalanlar ve sağ kalımı olmayanlar olarak 2 grupta incelendi.
Bulgular: Başvuru esnasındaki hs-cTnI ve d-dimer düzeyleri sağ kalımı olmayan CoVID-19 hastalarında anlamlı olarak daha yüksekti (her biri için p<0.005). Lojistik regresyon analizinde; yaş (OR=1.140, %95 CI: 1.045-1.244, p=0.003), bazal hs-cTnI (OR=1.022, %95 CI: 1.004-1.041, p=0.018) ve bazal d-dimer (OR=1.790, %95 CI: 1.078-2.972, p=0.024) düzeyleri COVID-19 hastalarında hastane-içi mortalitenin bağımsız prediktörleri olarak tespit edildi. Hastane-içi mortaliteyi öngörmede hs-cTnI için %100 duyarlılık ve %74 özgüllükle 18.6 ng/L kestirim değeri tespit edilirken; d-dimer için %93,3 duyarlılık ve %71,5 özgüllükle 1,41 mg/L kestirim değeri saptandı.
Sonuç: Başvuru sırasındaki hs-cTnI ve d-dimer düzeyleri COVID-19 tanısı alan yetişkin hastalarda hastane-içi mortaliteyi öngörmektedir.
References
- Zhu N, Zhang D, Wang W, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med 2020; 382 (8): 727-33.
- Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395 (10223): 497-506.
- Hendren NS, Drazner MH, Bozkurt B, Cooper LT, Jr. Description and Proposed Management of the Acute COVID-19 Cardiovascular Syndrome. Circulation2020.
- Deng Q, Hu B, Zhang Y, et al. Suspected myocardial injury in patients with COVID-19: Evidence from front-line clinical observation in Wuhan, China. Int J Cardiol 2020.
- Ammirati E, Wang DW. SARS-CoV-2 inflames the heart. The importance of awareness of myocardial injury in COVID-19 patients. Int J Cardiol 2020.
- Kochi AN, Tagliari AP, Forleo GB, Fassini GM, Tondo C. Cardiac and arrhythmic complications in patients with COVID-19. J Cardiovasc Electrophysiol 2020.
- Mishra AK, Sahu KK, Lal A, Sargent J. Patterns of heart Injury in COVID - 19 and relation to outcome. J Med Virol 2020.
- Klok FA, Kruip M, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 2020.
- Milbrandt EB, Reade MC, Lee M, et al. Prevalence and significance of coagulation abnormalities in community-acquired pneumonia. Mol Med 2009; 15 (11-12): 438-45.
- Corrales-Medina VF, Musher DM, Shachkina S, Chirinos JA. Acute pneumonia and the cardiovascular system. Lancet 2013; 381 (9865): 496-505.
- Udell JA, Zawi R, Bhatt DL, et al. Association between influenza vaccination and cardiovascular outcomes in high-risk patients: a meta-analysis. JAMA 2013; 310 (16):1711-20.
- Blackburn R, Zhao H, Pebody R, Hayward A, Warren-Gash C. Laboratory-Confirmed Respiratory Infections as Predictors of Hospital Admission for Myocardial Infarction and Stroke: Time-Series Analysis of English Data for 2004-2015. Clin Infect Dis 2018; 67 (1): 8-17.
- Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020; 18 (4):844-47.
- Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395 (10229):1054-62.
- Choi KW, Chau TN, Tsang O, et al. Outcomes and prognostic factors in 267 patients with severe acute respiratory syndrome in Hong Kong. Ann Intern Med 2003; 139 (9): 715-23.
- Choi WS, Kang CI, Kim Y, et al. Clinical Presentation and Outcomes of Middle East Respiratory Syndrome in the Republic of Korea. Infect Chemother 2016; 48 (2):118-26.
- Kim SW, Park JW, Jung HD, et al. Risk factors for transmission of Middle East respiratory syndrome coronavirus infection during the 2015 outbreak in South Korea. Clin Infect Dis 2017; 64 (5): 551-57.
- Sherbini N, Iskandrani A, Kharaba A, Khalid G, Abduljawad M, Al-Jahdali H. Middle East respiratory syndrome coronavirus in Al-Madinah City, Saudi Arabia: Demographic, clinical and survival data. J Epidemiol Glob Health 2017; 7 (1): 29-36.
- Park JE, Jung S, Kim A, Park JE. MERS transmission and risk factors: a systematic review. BMC Public Health 2018; 18 (1): 574.
- Zheng Z, Peng F, Xu B, et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. J Infect 2020.
- Du RH, Liang LR, Yang CQ, et al. Predictors of Mortality for Patients with COVID-19 Pneumonia Caused by SARS-CoV-2: A Prospective Cohort Study. Eur Respir J 2020.
- Licastro F, Candore G, Lio D, et al. Innate immunity and inflammation in ageing: a key for understanding age-related diseases. Immun Ageing 2005; 2:8.
- Plackett TP, Boehmer ED, Faunce DE, Kovacs EJ. Aging and innate immune cells. J Leukoc Biol2004; 76 (2): 291-99.
- Meyer KC. The role of immunity in susceptibility to respiratory infection in the aging lung. Respir Physiol2001; 128 (1):23-31.
- Smits SL, de Lang A, van den Brand JM, et al. Exacerbated innate host response to SARS-CoV in aged non-human primates. PLoS Pathog2010; 6 (2):e1000756.
- Opal SM, Girard TD, Ely EW. The immunopathogenesis of sepsis in elderly patients. Clin Infect Dis2005; 41 Suppl 7: S504-12.
- Corrales-Medina VF, Musher DM, Wells GA, Chirinos JA, Chen L, Fine MJ. Cardiac complications in patients with community-acquired pneumonia: incidence, timing, risk factors, and association with short-term mortality. Circulation 2012; 125 (6):773-81.
- 28. Violi F, Cangemi R, Falcone M, et al. Cardiovascular Complications and Short-term Mortality Risk in Community-Acquired Pneumonia. Clin Infect Dis 2017; 64 (11): 1486-93.
- Mandal P, Chalmers JD, Choudhury G, Akram AR, Hill AT. Vascular complications are associated with poor outcome in community-acquired pneumonia. QJM 2011; 104 (6): 489-95.
- Cangemi R, Calvieri C, Falcone M, et al. Relation of Cardiac Complications in the Early Phase of Community-Acquired Pneumonia to Long-Term Mortality and Cardiovascular Events. Am J Cardiol 2015; 116 (4): 647-51.
- Frencken JF, van Baal L, Kappen TH, et al. Myocardial Injury in Critically Ill Patients with Community-acquired Pneumonia. A Cohort Study. Ann Am Thorac Soc 2019; 16 (5): 606-12.
- Guo T, Fan Y, Chen M, et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol 2020.
- Tersalvi G, Vicenzi M, Calabretta D, Biasco L, Pedrazzini G, Winterton D. Elevated troponin in patients with Coronavirus Disease 2019 (COVID-19): possible mechanisms. J Card Fail 2020.
- Zhang L, Long Y, Xiao H, Yang J, Toulon P, Zhang Z. Use of D-dimer in oral anticoagulation therapy. Int J Lab Hematol 2018.
- Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020.
- Barrett CD, Moore HB, Yaffe MB, Moore EE. ISTH interim guidance on recognition and management of coagulopathy in COVID-19: A Comment. J Thromb Haemost 2020.
- Liu Q, Zhou YH, Yang ZQ. The cytokine storm of severe influenza and development of immunomodulatory therapy. Cell Mol Immunol 2016; 13 (1): 3-10.
- Wong JP, Viswanathan S, Wang M, Sun LQ, Clark GC, D'Elia RV. Current and future developments in the treatment of virus-induced hypercytokinemia. Future Med Chem 2017; 9 (2):169-178.
- Levi M, van der Poll T. Coagulation and sepsis. Thromb Res 2017; 149:38-44.
- Ninivaggi M, de Laat M, Lance MM, et al. Hypoxia Induces a Prothrombotic State Independently of the Physical Activity. PLoS One 2015; 10 (10): e0141797.
- Mari D, Mannucci PM, Coppola R, Bottasso B, Bauer KA, Rosenberg RD. Hypercoagulability in centenarians: the paradox of successful aging. Blood 1995; 85 (11): 3144-3149.
- Mari D, Ogliari G, Castaldi D, Vitale G, Bollini EM, Lio D. Hemostasis and ageing. Immun Ageing 2008; 5: 12.
- Iba T, Levy JH, Warkentin TE, et al. Diagnosis and management of sepsis-induced coagulopathy and disseminated intravascular coagulation. J Thromb Haemost 2019; 17 (11): 1989-1994.
- Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020.
- Zhang J, Wang X, Jia X, et al. Risk factors for disease severity, unimprovement, and mortality of COVID-19 patients in Wuhan, China. Clin Microbiol Infect 2020.
There are 45 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | June 30, 2021 |
| Submission Date | August 1, 2020 |
| Published in Issue | Year 2021 |
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