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Intern Emerg Med
. 2020 Sep 27.
doi: 10.1007/s11739-020-02495-w. Online ahead of print.
Cardiac injury and mortality in patients with Coronavirus disease 2019 (COVID-19): insights from a mediation analysis
Alberto Cipriani 1 2 , Federico Capone 3 4 , Filippo Donato 5 4 , Leonardo Molinari 3 4 , Davide Ceccato 3 4 , Alois Saller 3 4 , Lorenzo Previato 3 4 , Raffaele Pesavento 3 4 , Cristiano Sarais 5 4 , Paola Fioretto 3 4 , Sabino Iliceto 5 4 , Dario Gregori 5 4 , Angelo Avogaro 3 4 , Roberto Vettor 3 4
Affiliations
- PMID: 32984929
- DOI: 10.1007/s11739-020-02495-w
Abstract
Backgrounds: Patients at greatest risk of severe clinical conditions from coronavirus disease 2019 (COVID-19) and death are elderly and comorbid patients. Increased levels of cardiac troponins identify patients with poor outcome. The present study aimed to describe the clinical characteristics and outcomes of a cohort of Italian inpatients, admitted to a medical COVID-19 Unit, and to investigate the relative role of cardiac injury on in-hospital mortality.
Methods and results: We analyzed all consecutive patients with laboratory-confirmed COVID-19 referred to our dedicated medical Unit between February 26th and March 31st 2020. Patients' clinical data including comorbidities, laboratory values, and outcomes were collected. Predictors of in-hospital mortality were investigated. A mediation analysis was performed to identify the potential mediators in the relationship between cardiac injury and mortality. A total of 109 COVID-19 inpatients (female 36%, median age 71 years) were included. During in-hospital stay, 20 patients (18%) died and, compared with survivors, these patients were older, had more comorbidities defined by Charlson comorbidity index ≥ 3(65% vs 24%, p = 0.001), and higher levels of high-sensitivity cardiac troponin I (Hs-cTnI), both at first evaluation and peak levels. A dose-response curve between Hs-cTnI and in-hospital mortality risk up to 200 ng/L was detected. Hs-cTnI, chronic kidney disease, and chronic coronary artery disease mediated most of the risk of in-hospital death, with Hs-cTnI mediating 25% of such effect. Smaller effects were observed for age, lactic dehydrogenase, and D-dimer.
Conclusions: In this cohort of elderly and comorbid COVID-19 patients, elevated Hs-cTnI levels were the most important and independent mediators of in-hospital mortality.
Keywords: COVID-19; Cardiac injury; Cardiac troponin; Coronavirus 2019.