tetano
Editor, Senior Moderator
JAMA Cardiol
. 2020 Aug 26.
doi: 10.1001/jamacardio.2020.3538. Online ahead of print.
Association of Troponin Levels With Mortality in Italian Patients Hospitalized With Coronavirus Disease 2019: Results of a Multicenter Study
Carlo Mario Lombardi[SUP] 1 [/SUP], Valentina Carubelli[SUP] 1 [/SUP], Annamaria Iorio[SUP] 2 [/SUP], Riccardo M Inciardi[SUP] 1 [/SUP], Antonio Bellasi[SUP] 3 [/SUP], Claudia Canale[SUP] 4 [/SUP], Rita Camporotondo[SUP] 5 [/SUP], Francesco Catagnano[SUP] 6 [/SUP], Laura A Dalla Vecchia[SUP] 7 [/SUP], Stefano Giovinazzo[SUP] 4 [/SUP], Gloria Maccagni[SUP] 1 8 [/SUP], Massimo Mapelli[SUP] 9 10 [/SUP], Davide Margonato[SUP] 6 11 [/SUP], Luca Monzo[SUP] 12 13 [/SUP], Vincenzo Nuzzi[SUP] 14 [/SUP], Chiara Oriecuia[SUP] 15 16 [/SUP], Giulia Peveri[SUP] 10 15 [/SUP], Andrea Pozzi[SUP] 2 [/SUP], Giovanni Provenzale[SUP] 17 [/SUP], Filippo Sarullo[SUP] 18 [/SUP], Daniela Tomasoni[SUP] 1 [/SUP], Pietro Ameri[SUP] 4 [/SUP], Massimiliano Gnecchi[SUP] 5 19 [/SUP], Sergio Leonardi[SUP] 5 19 [/SUP], Marco Merlo[SUP] 14 [/SUP], Piergiuseppe Agostoni[SUP] 9 10 [/SUP], Stefano Carugo[SUP] 17 [/SUP], Gian Battista Danzi[SUP] 8 [/SUP], Marco Guazzi[SUP] 20 21 [/SUP], Maria Teresa La Rovere[SUP] 22 [/SUP], Andrea Mortara[SUP] 6 [/SUP], Massimo Piepoli[SUP] 23 24 [/SUP], Italo Porto[SUP] 4 [/SUP], Gianfranco Sinagra[SUP] 14 [/SUP], Maurizio Volterrani[SUP] 25 [/SUP], Claudia Specchia[SUP] 15 [/SUP], Marco Metra[SUP] 1 [/SUP], Michele Senni[SUP] 2 [/SUP]
Affiliations
Abstract
Importance: Myocardial injury, detected by elevated plasma troponin levels, has been associated with mortality in patients hospitalized with coronavirus disease 2019 (COVID-19). However, the initial data were reported from single-center or 2-center studies in Chinese populations. Compared with these patients, European and US patients are older, with more comorbidities and higher mortality rates.
Objective: To evaluate the prevalence and prognostic value of myocardial injury, detected by elevated plasma troponin levels, in a large population of White Italian patients with COVID-19.
Design, setting, and participants: This is a multicenter, cross-sectional study enrolling consecutive patients with laboratory-confirmed COVID-19 who were hospitalized in 13 Italian cardiology units from March 1 to April 9, 2020. Patients admitted for acute coronary syndrome were excluded. Elevated troponin levels were defined as values greater than the 99th percentile of normal values.
Main outcomes and measures: Clinical characteristics and outcomes stratified as elevated or normal cardiac troponin levels at admission, defined as troponin T or troponin I at a level greater than the 99th percentile of normal values.
Results: A total of 614 patients with COVID-19 were included in this study (mean age [SD], 67 [13] years; 70.8% male), of whom 148 patients (24.1%) died during the hospitalization. Elevated troponin levels were found in 278 patients (45.3%). These patients were older (mean [SD] age, 64.0 [13.6] years vs 71.3 [12.0] years; P < .001) and had higher prevalence of hypertension (168 patients [50.5%] vs 182 patients [65.9%]; P < .001), heart failure (24 [7.2%]; 63 [22.8%]; P < .001), coronary artery disease (50 [15.0%] vs 87 [31.5%]; P < .001), and atrial fibrillation (33 [9.9%] vs 67 [24.3%]; P < .001). Elevated troponin levels were associated with an increased in-hospital mortality (37% vs 13%; HR, 1.71 [95% CI, 1.13-2.59]; P = .01 via multivariable Cox regression analysis), and this was independent from concomitant cardiac disease. Elevated troponin levels were also associated with a higher risk of in-hospital complications: heart failure (44 patients [19.2%] vs 7 patients [2.9%]; P < .001), sepsis (31 [11.7%] vs 21 [6.4%]; P = .03), acute kidney failure (41 [20.8%] vs 13 [6.2%]; P < .001), multiorgan failure (21 [10.9%] vs 6 [2.9%]; P = .003), pulmonary embolism (27 [9.9%] vs 17 [5.2%]; P = .04), delirium (13 [6.8%] vs 3 [1.5%]; P = .02), and major bleeding (16 [7.0%] vs 4 [1.6%]; P = .008).
Conclusions and relevance: In this multicenter, cross-sectional study of Italian patients with COVID-19, elevated troponin was an independent variable associated with in-hospital mortality and a greater risk of cardiovascular and noncardiovascular complications during a hospitalization for COVID-19.
. 2020 Aug 26.
doi: 10.1001/jamacardio.2020.3538. Online ahead of print.
Association of Troponin Levels With Mortality in Italian Patients Hospitalized With Coronavirus Disease 2019: Results of a Multicenter Study
Carlo Mario Lombardi[SUP] 1 [/SUP], Valentina Carubelli[SUP] 1 [/SUP], Annamaria Iorio[SUP] 2 [/SUP], Riccardo M Inciardi[SUP] 1 [/SUP], Antonio Bellasi[SUP] 3 [/SUP], Claudia Canale[SUP] 4 [/SUP], Rita Camporotondo[SUP] 5 [/SUP], Francesco Catagnano[SUP] 6 [/SUP], Laura A Dalla Vecchia[SUP] 7 [/SUP], Stefano Giovinazzo[SUP] 4 [/SUP], Gloria Maccagni[SUP] 1 8 [/SUP], Massimo Mapelli[SUP] 9 10 [/SUP], Davide Margonato[SUP] 6 11 [/SUP], Luca Monzo[SUP] 12 13 [/SUP], Vincenzo Nuzzi[SUP] 14 [/SUP], Chiara Oriecuia[SUP] 15 16 [/SUP], Giulia Peveri[SUP] 10 15 [/SUP], Andrea Pozzi[SUP] 2 [/SUP], Giovanni Provenzale[SUP] 17 [/SUP], Filippo Sarullo[SUP] 18 [/SUP], Daniela Tomasoni[SUP] 1 [/SUP], Pietro Ameri[SUP] 4 [/SUP], Massimiliano Gnecchi[SUP] 5 19 [/SUP], Sergio Leonardi[SUP] 5 19 [/SUP], Marco Merlo[SUP] 14 [/SUP], Piergiuseppe Agostoni[SUP] 9 10 [/SUP], Stefano Carugo[SUP] 17 [/SUP], Gian Battista Danzi[SUP] 8 [/SUP], Marco Guazzi[SUP] 20 21 [/SUP], Maria Teresa La Rovere[SUP] 22 [/SUP], Andrea Mortara[SUP] 6 [/SUP], Massimo Piepoli[SUP] 23 24 [/SUP], Italo Porto[SUP] 4 [/SUP], Gianfranco Sinagra[SUP] 14 [/SUP], Maurizio Volterrani[SUP] 25 [/SUP], Claudia Specchia[SUP] 15 [/SUP], Marco Metra[SUP] 1 [/SUP], Michele Senni[SUP] 2 [/SUP]
Affiliations
- PMID: 32845276
- DOI: 10.1001/jamacardio.2020.3538
Abstract
Importance: Myocardial injury, detected by elevated plasma troponin levels, has been associated with mortality in patients hospitalized with coronavirus disease 2019 (COVID-19). However, the initial data were reported from single-center or 2-center studies in Chinese populations. Compared with these patients, European and US patients are older, with more comorbidities and higher mortality rates.
Objective: To evaluate the prevalence and prognostic value of myocardial injury, detected by elevated plasma troponin levels, in a large population of White Italian patients with COVID-19.
Design, setting, and participants: This is a multicenter, cross-sectional study enrolling consecutive patients with laboratory-confirmed COVID-19 who were hospitalized in 13 Italian cardiology units from March 1 to April 9, 2020. Patients admitted for acute coronary syndrome were excluded. Elevated troponin levels were defined as values greater than the 99th percentile of normal values.
Main outcomes and measures: Clinical characteristics and outcomes stratified as elevated or normal cardiac troponin levels at admission, defined as troponin T or troponin I at a level greater than the 99th percentile of normal values.
Results: A total of 614 patients with COVID-19 were included in this study (mean age [SD], 67 [13] years; 70.8% male), of whom 148 patients (24.1%) died during the hospitalization. Elevated troponin levels were found in 278 patients (45.3%). These patients were older (mean [SD] age, 64.0 [13.6] years vs 71.3 [12.0] years; P < .001) and had higher prevalence of hypertension (168 patients [50.5%] vs 182 patients [65.9%]; P < .001), heart failure (24 [7.2%]; 63 [22.8%]; P < .001), coronary artery disease (50 [15.0%] vs 87 [31.5%]; P < .001), and atrial fibrillation (33 [9.9%] vs 67 [24.3%]; P < .001). Elevated troponin levels were associated with an increased in-hospital mortality (37% vs 13%; HR, 1.71 [95% CI, 1.13-2.59]; P = .01 via multivariable Cox regression analysis), and this was independent from concomitant cardiac disease. Elevated troponin levels were also associated with a higher risk of in-hospital complications: heart failure (44 patients [19.2%] vs 7 patients [2.9%]; P < .001), sepsis (31 [11.7%] vs 21 [6.4%]; P = .03), acute kidney failure (41 [20.8%] vs 13 [6.2%]; P < .001), multiorgan failure (21 [10.9%] vs 6 [2.9%]; P = .003), pulmonary embolism (27 [9.9%] vs 17 [5.2%]; P = .04), delirium (13 [6.8%] vs 3 [1.5%]; P = .02), and major bleeding (16 [7.0%] vs 4 [1.6%]; P = .008).
Conclusions and relevance: In this multicenter, cross-sectional study of Italian patients with COVID-19, elevated troponin was an independent variable associated with in-hospital mortality and a greater risk of cardiovascular and noncardiovascular complications during a hospitalization for COVID-19.