Research Article
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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

Year 2021, Volume 60, Issue 2, 113 - 120, 30.06.2021
https://doi.org/10.19161/etd.950576

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.

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

Year 2021, Volume 60, Issue 2, 113 - 120, 30.06.2021
https://doi.org/10.19161/etd.950576

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.

Details

Primary Language English
Subjects Health Care Sciences and Services
Journal Section Research Articles
Authors

Gökhan ALICI This is me
Prof. Dr. Cemal Taşcıoğlu City Hospital, Department of Cardiology, Istanbul
0000-0002-4589-7566
Türkiye


Hazar HARBALIOĞLU This is me
Düzce Atatürk State Hospital, Department of Cardiology, Düzce
Türkiye


Ömer GENÇ This is me (Primary Author)
Ağrı Training and Research Hospital, Department of Cardiology, Ağrı
0000-0002-9097-5391
Türkiye


Samir ALLAHVERDİYEV This is me
Istanbul Aydın University VM Medical Park Florya Hospital, Department of Cardiology, Istanbul
0000-0003-3175-0835
Türkiye


Abdullah YILDIRIM This is me
Adana City Training and Research Hospital, Department of Cardiology, Adana
0000-0002-7071-8099
Türkiye


Fahri ER This is me
Ağrı Training and Research Hospital, Department of Cardiology, Ağrı
0000-0002-5016-5511
Türkiye


İbrahim Halil KURT This is me
Adana City Training and Research Hospital, Department of Cardiology, Adana
0000-0001-5007-2246
Türkiye


Alaa QUİSİ This is me
Medline Hospital Adana, Department of Cardiology, Adana
0000-0002-5862-5789
Türkiye

Publication Date June 30, 2021
Application Date August 1, 2020
Acceptance Date January 21, 2021
Published in Issue Year 2021, Volume 60, Issue 2

Cite

Vancouver Alıcı G. , Harbalıoğlu H. , Genç Ö. , Allahverdiyev S. , Yıldırım A. , Er F. , Kurt İ. H. , Quisi A. 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. Ege Tıp Dergisi. 2021; 60(2): 113-120.