Study of 1,020 COVID-19-positive patients shows higher hs-cTnI levels = higher rates of mechanical ventilation

1,020 COVID-19-positive patients: higher hs-cTnI levels = higher rates of mechanical ventilation

One of the largest studied cohorts in the U.S. describing cardiac injury and its associated outcomes in patients hospitalized with COVID-19 consisted of 1,020 patients admitted to Henry Ford Health System in Michigan, U.S. The study sought to evaluate the outcomes of U.S. patients with cardiovascular comorbidities, determine factors associated with cardiac injury and examine the association of cardiac injury with the severity of illness in patients with COVID-19. The patients in the study were ≥18 years of age, diagnosed with SARS-CoV-2 and hospitalized. Once the patients were admitted with COVID-19, they had hs-cTnI and inflammatory markers such as D-dimer, lactate dehydrogenase, ferritin and C-reactive protein performed in the ED.

The study concluded:

  • The multivariate logistic regression analysis identified independent predictors, including age ≥65, atrial fibrillation, cerebrovascular disease, D-dimer quartiles, hs-cTnI categories (<18, >18-99, and >100 ng/L), and ARDS
  • Patients with cardiac injury were more likely to have elevated D-dimer levels (1.9 vs 1.1 mg/ml, p <0.001), raising the possibility of microthrombi formation as another mechanism by which cardiac injury occurs
  • Using presenting hs-cTnI trends, patients with higher levels by categories ≤18 ng/L, >18−99 ng/L, and ≥100 ng/L were more likely to develop in-hospital complications and adverse events including acute kidney injury, need for renal replacement therapy, mechanical ventilation, ICU transfer, and mortality
  • Patients with higher peak hs-cTnI levels during admission had significantly higher rates of mechanical ventilation or death

Overall, the presence of cardiovascular risk factors was associated with an increased risk of developing cardiac injury in patients admitted with COVID-19. The extent of cardiac injury was associated with worse outcomes, including mortality.

At a Glance

1020
Patients with COVID-19 were studied
63
Median age of patients studied
66 %
Of patients with high sensitivity troponin levels ≥ 100 ng/L experienced in-hospital outcomes of going to the ICU, needing mechanical ventilation and resulted in mortality
Source: Raad, M., Dabbagh, M., Gorgis, S., Yan, J., Chehab, O., Dagher, C., Jamoor, K., Hussein, I. H., Cook, B., Van Harn, M., Singh, G., McCord, J., & Parikh, S. (2020). Cardiac Injury Patterns and Inpatient Outcomes Among Patients Admitted With COVID-19. The American Journal of Cardiology, 133, 154–161. https://doi.org/10.1016/j.amjcard.2020.07.040